Akira Doshu-Kajiura1, Junko Suzuki2, Takahiro Suzuki2. 1. Department of Anesthesiology, Nihon University, School of Medicine, 30-1, Oyaguchi, Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan. akiracch1224@yahoo.co.jp. 2. Department of Anesthesiology, Nihon University, School of Medicine, 30-1, Oyaguchi, Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan.
Abstract
BACKGROUND: Drugs administered subcutaneously have delayed onset and prolonged duration of action versus those given intravenously. Since the duration of action of rocuronium is prolonged in patients with renal dysfunction, subcutaneous administration of rocuronium to such patients might significantly prolong its effect. CASE PRESENTATION: A 51-year-old female with chronic renal failure was accidentally administered 1.04 mg/kg rocuronium subcutaneously. Marked prolongation of onset and duration of action of rocuronium were detected on acceleromyography. Slow development of the neuromuscular block was still observed at 100 min after injection. Administration of 4.5 mg/kg sugammadex at 140 min after rocuronium injection facilitated recovery from a train-of-four (TOF) count of 2 to a TOF ratio of 100% within 5 min. No symptoms of postoperative recurarization and upper airway obstruction were observed. CONCLUSION: Neuromuscular monitoring is necessary to evaluate the progress and depth of neuromuscular block, particularly when rocuronium is inadvertently administered subcutaneously.
BACKGROUND: Drugs administered subcutaneously have delayed onset and prolonged duration of action versus those given intravenously. Since the duration of action of rocuronium is prolonged in patients with renal dysfunction, subcutaneous administration of rocuronium to such patients might significantly prolong its effect. CASE PRESENTATION: A 51-year-old female with chronic renal failure was accidentally administered 1.04 mg/kg rocuronium subcutaneously. Marked prolongation of onset and duration of action of rocuronium were detected on acceleromyography. Slow development of the neuromuscular block was still observed at 100 min after injection. Administration of 4.5 mg/kg sugammadex at 140 min after rocuronium injection facilitated recovery from a train-of-four (TOF) count of 2 to a TOF ratio of 100% within 5 min. No symptoms of postoperative recurarization and upper airway obstruction were observed. CONCLUSION: Neuromuscular monitoring is necessary to evaluate the progress and depth of neuromuscular block, particularly when rocuronium is inadvertently administered subcutaneously.
Authors: L M Staals; M M J Snoeck; J J Driessen; H W van Hamersvelt; E A Flockton; M W van den Heuvel; J M Hunter Journal: Br J Anaesth Date: 2010-01 Impact factor: 9.166