RECOVERY RACE AGAINST ROCURONIUM: A CASE REPORT

*Dr. Shibu Sasidharan, Dr. Shishir Kumar and Dr. Sarvesh Srivastava

ABSTRACT

We describe a case of delayed recovery from neuromuscular blockade by Inj. Rocuronium in a patient undergoing laparoscopic surgery. INTRODUCTION: Laparoscopic procedures have replaced a variety of open intra-abdominal surgeries, because it is a relatively non-invasive procedure with fast recovery and less pain.[1] Neuromuscular block is necessary for optimizing surgical field during pneumoperitoneum[6] and preventing abdominal compartment syndrome.[7] However, laparoscopy requires a formation of the working area within the peritoneal cavity, and this is commonly achieved by carbon dioxide (CO2) pneumoperitoneum (PP), which raises concerns regarding the physiologic adverse effects.[2,3] An increased intra-abdominal pressure by CO2 inflation may cause significant changes in the hepatic function and blood flow.[4,5] Rocuronium bromide is a widely used non-depolarizing neuromuscular blocking agent, because of its rapid onset and intermediate duration of action. Although its elimination pathway remains unclear, some hepatic elimination of compound in humans might be expected. In patients with decreased hepatic function, rocuronium pharmacodynamic and pharmacokinetic alterations have been reporterd.[10-12] In addition, Wang et al.[13] reported that the effect of rocurnium was prolonged in patients with obstructive jaundice and cautioned that monitoring the post-opera tive residual neuromuscular blockade should be needed in these patients.

Keywords: decreased hepatic function, rocuronium pharmacodynamic and pharmacokinetic alterations.