Is vecuronium toxicity abolished by hemodialysis? A case report

Vecuronium is a curaric agent, largely used in anesthesia. Indications as t o its employ in uremic patients appear to be debated because of partial ren al elimination of the drug. A 52-year-old hemodialyzed woman required trans plantectomy for rejection. At awakeness after general anesthesia (induced w ith fentanyl, propofol, and 6 mg of vecuronium, repeated with a single 2 mg dose 30 min later), she presented diafragmatic and muscular limb weakeness that lasted 180 min in spite of prostigmine administration. A 2 h 30 min p redilutional hemofiltration was then performed, which induced rapid disappe arance of neuromuscular blockade. Even if vecuronium can be used in dialysi s patients, one should remember its possible side effects, especially with repeated doses, in determining prolonged neuromuscular blockade. Cautious u se of this drug in renal failure is mandatory. Low dosage must be employed and repeated administration avoided. Neuromuscular blockade seems to be rap idly reversible with dialytic treatment.