Atracurium resistance in a critically Ill patient.

Abstract

A previously healthy 25-year-old man with metastatic testicular teratocarcinoma became resistant to atracurium-induced neuromuscular blockade as evidenced by train-of-four (TOF) monitoring combined with clinical assessment. Subsequently he had an adequate response with a standard dosage of pancuronium. During the first 10 days of neuromuscular blockade, the atracurium requirements escalated from 0.31 to 1.7 mg/kg/hour, guided by TOF monitoring, movement, and spontaneous respirations. The infusion was discontinued but later reinstituted. Despite a total atracurium loading dose of 1.4 mg/kg followed by an infusion rate titrated to 1.7 mg/kg/hour, inadequate paralysis persisted. Atracurium was terminated and an intravenous infusion of pancuronium 0.10 mg/kg/hour was started. Over the next 3 days the pancuronium infusion was titrated down to a range of 0.04-0.06 mg/kg/hour, followed by a maintenance infusion of 0.01-0.05 mg/kg/hour for 5 days. A pharmacokinetic alteration, such as increased metabolism or elimination, may have caused the atracurium resistance.

• Authors: S J Tschida, L L Hoey, A Nahum, K Vance-Bryan
• Journal: Pharmacotherapy (Pharmacotherapy) 1995 Jul-Aug Vol. 15 Issue 4 Pg. 533-9 ISSN: 0277-0008 [Print] United States
• PMID: 7479210 (Publication Type: Case Reports, Journal Article)

Chemical References

• Neuromuscular Nondepolarizing Agents
• Atracurium
• Pancuronium

Topics

• Adult
• Atracurium (administration & dosage)
• Critical Illness
• Drug Resistance
• Humans
• Infusions, Intravenous
• Male
• Neuromuscular Junction (drug effects)
• Neuromuscular Nondepolarizing Agents
• Pancuronium (administration & dosage)
• Teratocarcinoma (therapy)
• Testicular Neoplasms (therapy)