Cylcosporinepancuronium interaction in a patient with a renal allograft

摘要: A case is described of a 54-year-old 55 kg patient who presented for clipping middle cerebral aneurysm two years after successful renal allograft. Immunosuppression was maintained with azathioprine 100 mg daily, cyclosporin 300 daily and prednisone 10 daily. The had chronic hypertension controlled nifedipine 40 furosemide 20 cyclosporine level taken on the morning surgery 166 œ,g·L-1. Induction anaesthesia consisted fentanyl 350 œg, thiopentone 125 pancuronium 5.5 mg. Anaesthesia nitrous oxide 70 per cent in oxygen isoflurane 0.5-1 .5 cent. No additional doses were given during four hour surgical procedure. At end surgery, twitches present train-of-four stimulation, but evidence residual muscle paralysis present. Residual neuromuscular blockade reversed atropine 1.2 neostigmine2.5 Recovery Room edrophonium prior to extubation. Clinical testing demonstrated adequate reversal blockade. Twenty minutes following extubation, increasing respiratory distress noted. There clinical paralysis. re-intubated. It proposed that potentiated producing prolonged relaxation resulting surgery. potential interactions relaxants deserve further study. On decrit le cas ďun qui s’est presente pour clampage ďanevrisme de ľartere cerebrale moyenne deux ans apres une greffe renale. Ľimmunosuppression etait maintenue avec ľazathioprine par jour, jour et jour. Le presentait ľhypertension chronique controlee la du niveau pris matin chirurgie œg·L-1 Ľinduction ľ anesthesie comprenait dufentanyl œ,g, Ľanesthesie protoxyde ďazote dans ľoxygene deľ 0.5 a1 Aucune dose additionnelle n’etait donnee pendant les quatre heures procedure chirurgicale. fin “twitches” etaient presents lors stimulation “ondee-de-quatre” (train-of-four) mais aucune paralysie musculaire residuelle presente. Une blocage neuromusculaire residuel antagonise ľatropine neostigmine 2.5 en salle reveil ľedrophonium donne avant ľextubation. Les tests cliniques ont demontre un antagonisme adequat neuromusculaire. Vingt ľextubation detresse respiratoire croissante fut notee. ll y avait clinique musculaire. reintube. propose que potentialise prolonge provoquant chirurgie. Ľinteraction possible des musculaires meritent ďautres etudes.