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Prolonged (more than ten hours) neuromuscular blockade after cardiac surgery: report of two cases

[Un blocage neuromusculaire prolongé (plus de dix heures) après une intervention en cardiochirurgie : présentation de deux cas]

From the Department of Anesthesia, McGill University and McGill University Health Centre, Royal Victoria Hospital, Montreal, Quebec, Canada.

Address correspondence to: Dr. Gilles Plourde, Department of Anesthesia, MUHC – Royal Victoria Hospital, Room S5.05, 687 Pine Avenue West, Montreal, Quebec H3A 1A1, Canada. Phone: 514-934-1934, ext. 34880; Fax: 514-843-1723; E-mail: gilles.plourde{at}staff.mcgill.ca

Purpose: We examine two cases of prolonged neuromuscular blockade (NMB) after cardiac surgery. To the best of our knowledge, these are the first reported cases of complete paralysis lasting more than ten hours after surgery.

Clinical features: We attribute the extended durations of NMB (more than ten hours) to high doses of NMB drugs in combination with magnesium sulphate and moderate renal failure. Advanced age, hepatic disease, aminoglycoside exposure, hypocalcemia, and possible interaction between rocuronium and pancuronium may have played minor roles.

Conclusion: We should avoid administering large doses of NMB agents, even in the context of planned postoperative ventilation. If NMB is not monitored intraoperatively in patients who are at risk of prolonged NMB, then train-of-four response should be measured in the intensive care unit. Adequate sedation should be provided until proper recovery of neuromuscular function is documented.

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