Marked prolongation of the succinylcholine effect two hours after neostigmine reversal of neuromuscular blockade in a patient with chronic renal insufficiency

Prolonged neuromuscular blockade from succinylcholine after neostigmine adm inistration has been reported in patients with frank renal failure, We pres ent a case of prolonged neuromuscular blockade from succinylcholine adminis tration, given 2 hours after neostigmine reversal of neuromuscular blockade in a patient with chronic renal insufficiency. This case shows that patien ts with chronic renal insufficiency, like patients with renal failure, are at risk for prolonged succinylcholine blockade if they have recently receiv ed anticholinesterase reversal of neuromuscular blockade, Administration of succinylcholine for facilitation of urgent endotracheal intubation may be required soon after reversal of nondepolarizing muscle relaxants, particula rly in patients who return to the operating room for emergency care.