NEUROMUSCULAR BLOCKADE WITH ACUTE RESPIRATORY-FAILURE IN A PATIENT RECEIVING CIBENZOLINE

Cibenzoline is a class Ic antiarrhythmic agent that can be used to tre at supraventricular arrhythmias. A case is reported of cibenzoline ove rdose in a patient with impaired renal function, leading not only to t he usual cardiac and metabolic symptoms (bradycardia and hypoglycaemia ), but also to a myastheniform syndrome with acute respiratory failure . Neuromuscular blockade was demonstrated by repetitive supramaximal s timulation of the median nerve, and diaphragmatic involvement was evid enced by applying the same protocol to the phrenic nerve. Muscle stren gth recovered as serum cibenzoline levels decreased, allowing the pati ent to be weaned from the ventilator. This observation suggests that c ibenzoline, like other antiarrhythmic agents, can be responsible for n euromuscular blockade, and should therefore be used with caution in pa tients with neuromuscular and respiratory diseases or with impaired re nal function.