Abstract
Prolonged paralysis of 7 days in a patient who received 360mg of vecuronium infused continuously for 114 hours is reported.
A 63-year old male patient who had no evidence of neurological disorder entered the ICU after cardiac surgery. After cessation of continuous infusion of vecuronium, maximum levels of serum vecuronium and its metabolite, 3-hydroxyvecuronium, were 53.1 and 142.4ng·ml-1 respectively.
This suggests that the reason for the prolonged paralysis was the protracted period required metabolize and eliminate the vecuronium and its metabolite due to drug-induced liver dysfunction. Hypoproteinemia and the drugs used to treat it (antibiotics, Ca-channel blockers and diuretics) seemed to enhance the paralysis. We recommend the use of a peripheral nerve stimulator when the use of a muscle relaxant is necessary in a critical case setting.
