Abstract
An 18-yr-old male asthmatic was paralyzed with atracurium for a period of seven days to facilitate mechanical pulmonary ventilation. After withdrawal of the muscle relaxant, train-of-four neuromuscular monitoring demonstrated rapid recovery of normal function. Three days later he developed acute quadriparesis without respiratory compromise. Electrophysiological studies showed normal conduction velocities, low compound muscle action potential amplitudes and evidence of denervation. Most cases of post-ventilatory weakness in the ICU involve the use of vecuronium and pancuronium. It has been suggested that the steroid nucleus in these muscle relaxants may be responsible. Our patient developed generalised weakness after treatment with atracurium, a benzylisoquinolinium muscle relaxant. Thus, it appears that the steroid nucleus of vecuronium and pancuronium is not essential in causing post-ventilatory weakness.
Résumé
Un asthmatique de 18 ans est curarisè à l’atracurium pendant sept jours pour la ventilation mécanique. Après l’arrêt du myo-relaxant, la fonction neuromusculaire telle qu’évaluée au train-de-quatre récupère rapidement. Trois jours plus tard, le patient devient subitement quadriplégique sans atteinte respiratoire. A l’électrophysiologie, les vélocités de conduction sont normales, les composantes des potentiels d’action sont de faible amplitude et la dénervation est évidente. A l’unité de soins intensifs, la majorité des cas de faiblesse ventilatoire survient avec le vécu-ronium et le pancuronium. La cause du problème est ordinairement attribuée au noyau stéroïde de ces relaxants. Dans le cas présent, la faiblesse généralisée est survenue après un traitement à l’atracurium qui est dérivé du benzylisoquinolinium. Il ne semble donc pas que le noyau stéroïde du vécu-ronium et du pancuronium puisse être considéré comme le facteur essentiel de la faiblesse post-ventilatoire.
Article PDF
Similar content being viewed by others
References
Danon MJ, Carpenter S. Myopathy with thick filament (myosin) loss following prolonged paralysis with vecuronium during steroid treatment. Muscle Nerve 1991; 14: 1131–9.
Williams TJ, O’Hehir RE, Czarny D, Home M, Bowes G. Acute myopathy in severe acute asthma treated with intravenously administered corticosteroids. Am Rev Respir Dis 1988; 137: 460–3.
Gorson KC, Ropper AH. Acute respiratory failure neuropathy: a variant of critical illness polyneuropathy. Crit Care Med 1993; 21: 267–71.
Kupfer Y, Namba T, Kaldawi E, Tessler S. Prolonged weakness after long-term infusion of vecuronium bromide. Ann Intern Med 1992; 117: 484–6.
Griffin D, Fairman N, Coursin D, Rawsthorne L, Grossman JE. Acute myopathy during treatment of status asthmaticus with corticosteroids and steroidal muscle relaxants. Chest 1992; 102: 510–4.
Kupfer Y, Okrent DG, Twersky RA, Tessler S. Disuse atrophy in a ventilated patient with status asthmaticus receiving neuromuscular blockade. Crit Care Med 1987; 15: 795–6.
MacFarlane IA, Rosenthal FD Severe myopathy after status asthmaticus (Letter). Lancet 1977; 2: 615.
Sitwell LD, Weinshenker BG, Montpetit V, Reid D. Complete ophthalmoplegia as a complication of acute corticosteroid- and pancuronium-associated myopathy. Neurology 1991; 41: 921–2.
Apte-Kakade S. Rehabilitation of patients with quadriparesis after treatment of status asthmaticus with neuromuscular blocking agents and high-dose corticosteroids. Arch Phys Med Rehabil 1991; 72: 1024–8.
Gooch JL, Suchyta MR, Balbierz JM, Petajan JH, Clemmer TP. Prolonged paralysis after treatment with neuromuscular junction blocking agents. Crit Care Med 1991; 19: 1125–31.
Douglas JA, Tuxen DV, Home M, et al. Myopathy in severe asthma. Am Rev Respir Dis 1992; 146: 517–9.
Pollard B. Which drug — steroid or benzylisoquinolinium? Intensive Care Med 1993; 19: S86–90.
Kaplan PW, Rocha W, Sanders DB, D’Souza B, Spock A. Acute steroid-induced tetraplegia following status asthmaticus. Pediatrics 1986; 78: 121–3.
Zochodne DW, Bolton CF, Well G, et al. Critical illness polyneuropathy: a complication of sepsis and multiple organ failure. Brain 1987; 110: 819–42.
Bolton CF. Neuromuscular complications of sepsis. Intensive Care Med 1993; 19: S58–63.
Rouleaux G, Karpati G, Carpenter S, Soza M, Prescott S, Holland P. Glucocorticoid excess induces preferential depletion of myosin in denervated skeletal muscle fibres. Muscle Nerve 1987; 10: 428–38.
DuBois DC, Almon RR. A possible role for glucocorticoids in denervation atrophy. Muscle Nerve 1981; 4: 370–3.
Chad DA, Lacomis D. Critically ill patients with newly acquired weakness: the clinicopathological spectrum. Ann Neurol 1994; 35: 257–9.
Meyer KC, Prielipp RC, Grossman JE, Coursin DB. Prolonged weakness after infusion of atracurium in two intensive care unit patients. Anesth Analg 1994; 78: 772–4.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Tousignant, C.P., Bevan, D.R., Eisen, A.A. et al. Acute quadriparesis in an asthmatic treated with atracurium. Can J Anaesth 42, 224–227 (1995). https://doi.org/10.1007/BF03010682
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03010682