Abstract
We report a case in which onset time of succinylcholine (SCC) was normal but recovery from SCC-induced paralysis was delayed after administration of neostigmine to reverse the action of vecuronium. A 59-year-old woman who had chronic tonsillitis was scheduled for an elective tonsillectomy. The patient had no complications and was not under medication before the operation. Pre-operative examination showed no abnormal findings except premature ventricular contractions. Anesthesia was induced with thiamylal and vecuronium. After endotracheal intubation, anesthesia was maintained using sevoflurane in nitrous oxide and oxygen (GOS). The operation ended uneventfully and the endotracheal tube was removed after reversal of neuromuscular block with neostigmine. Sustained bleeding in the oral cavity was observed after extubation, so the surgeons decided to perform a hemostatic operation. Before re-operation, neuromuscular function was monitored and evaluated by measuring single twitch and train-of-four (TOF). The TOF was 100% before re-operation, which meant full recovery from the vecuronium-induced block. The orotracheal tube was placed with adequate muscle relaxation following crash induction with thiamylal at 250mg and SCC at 60mg. The anesthesia was maintained with GOS. During re-operation, the monitor showed prolonged neuromuscular blocking effect of SCC. The first twitch of the TOF reached 25% and 75% of the control value after 20min and 25min, respectively. We suggest that the prolonged paralysis following SCC administration may be mainly due to the neostigmine-induced reduction of pseudocholinesterase activity. We recommend monitoring neuromuscular function when administering SCC following the reversal of non-depolarizing block with neostigmine (anti-chE).
