Ga. Arndt et al., POSTOPERATIVE REPARALYSIS AFTER ROCURONIUM FOLLOWING NEBULIZED EPINEPHRINE, Canadian journal of anaesthesia, 44(3), 1997, pp. 321-324
Purpose: We report a case of postoperative reparalysis in the recovery
room, following nebulized epinephrine. The patient was pharmacologica
lly reversed with edrophonium after paralysis with rocuronium. Clinica
l findings: A 12-yr-old girl developed postoperative reparalysis follo
wing the intraoperative administration of rocuronium, A total of 0.92
mg . kg(-1) rocuronium was administered. After surgery; pharmacologica
l reversal sal was achieved with 20 mg edrophonium with 0.15 mg. atrop
ine sulfate iv 35 min after the last administration of rocuronium, Mus
cular relaxation was monitored using an ulnar peripheral nerve stimula
tor (PNS). After reversal, a full train-of-four and sustained tetanus
at 50 Wt were present. In the recovery room, following nebulized epine
phrine, the patient became apneic. The patient was paralyzed and an ul
nar PNS demonstrated only one faint twitch. The paralysis was reversed
with 1.5 mg neostigmine with 0.3 mg glycopyrrolate. Conclusion: Posto
perative reparalysis following rocuronium may be a cause of postoperat
ive respiratory distress. The definitive diagnosis is made using PNS a
nd observing the response to pharmacological reversal. Nebulized epine
phrine may have a previously undescribed role in the development of po
stoperative reparalysis.