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Potentiation of Rocuronium Bromide by Lithium Carbonate: A Case Report.
Kishimoto, Naotaka; Yoshikawa, Hiroyuki; Seo, Kenji.
Affiliation
  • Kishimoto N; Division of Dental Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8514, Japan.
  • Yoshikawa H; Division of Dental Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8514, Japan.
  • Seo K; Division of Dental Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8514, Japan.
Anesth Prog ; 67(3): 146-150, 2020 09 01.
Article in En | MEDLINE | ID: mdl-32992336
ABSTRACT
Lithium carbonate is a medication used for the management of various mental disorders. The present report describes a case of prolongation of rocuronium bromide in a patient concurrently taking lithium carbonate. A 64-year-old woman was scheduled to undergo cystectomy under general anesthesia. The patient took lithium carbonate (600 mg/d) for treatment of bipolar affective disorder. General anesthesia was induced with propofol, fentanyl, remifentanil, and sevoflurane. After loss of consciousness, rocuronium bromide (50 mg) was administered, and the trachea was intubated. Approximately 1 hour after the administration of rocuronium, the degree of residual muscle relaxant was evaluated using a nerve stimulation device. No muscle contraction occurred with train-of-four (TOF) stimulation. Following administration of sugammadex (200 mg) the TOF ratio increased to 95%. The ionic size of lithium is similar to that of sodium; therefore, lithium is transported into the cell with sodium. The resting membrane potential decreases, leading to a reduction in the height of the action potential. Thus, the effect of the remaining lithium may have been superimposed on the rocuronium neuromuscular blockade. Evaluation with a nerve stimulation device in patients taking lithium is crucial before extubation because of the risk of rocuronium potentiation.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Neuromuscular Nondepolarizing Agents / Neuromuscular Blockade Limits: Female / Humans / Middle aged Language: En Journal: Anesth Prog Year: 2020 Document type: Article Affiliation country: Japan Publication country: EEUU / ESTADOS UNIDOS / ESTADOS UNIDOS DA AMERICA / EUA / UNITED STATES / UNITED STATES OF AMERICA / US / USA

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Neuromuscular Nondepolarizing Agents / Neuromuscular Blockade Limits: Female / Humans / Middle aged Language: En Journal: Anesth Prog Year: 2020 Document type: Article Affiliation country: Japan Publication country: EEUU / ESTADOS UNIDOS / ESTADOS UNIDOS DA AMERICA / EUA / UNITED STATES / UNITED STATES OF AMERICA / US / USA