Residual neuromuscular blockade in the immediate postoperative period

Prolonged paralysis and apnea after receiving a neuromuscular blocking agent: what nurses should know

After receiving mivacurium, a short-acting neuromuscular blocking agent used for intubation before surgery, a patient experienced prolonged paralysis and prolonged apnea that required ventilator support. Although this complication is rare, all critical care nurses should be aware of it so they can be competent in managing and providing holistic and comprehensive nursing care to the patient and the patient's family. Although this complication has been documented in the anesthesia literature, it has received little mention in critical care nursing journals.

A case of pseudocholinesterase deficiency in the PACU

A 39-year-old patient with unrecognized atypical pseudocholinesterase was given succinylcholine during the rapid-sequence induction process and subsequently had a prolonged neuromuscular blockade. The patient was reassured, sedated, and ventilated in the postanesthesia care unit (PACU). The primary nursing interventions included airway clearance, communication, comfort, and patient education. Several important learning experiences occurred for the nurses in the PACU related to identifying possible causes, ordering the pseudocholinesterase and dibucaine inhibition test, interpreting the results, and developing and delivering patient education. This article will provide the perianesthesia nurse with the fundamental understanding of the physiology, laboratory diagnostic interpretation, and nursing interventions needed to deliver evidence-based, high-quality care to patients diagnosed with pseudocholinesterase deficiency.

Prolonged paralysis related to mivacurium: A case study

Pseudocholinesterase deficiency is usually identified when an anesthetized patient has prolonged paralysis after receiving neuromuscular blocking agents dependent on pseudocholinesterase enzymes for hydrolysis. This rare complication, most frequently associated with succinylcholine, can occur with the use of mivacurium, one of the newer nondepolarizing muscle relaxants also hydrolyzed by pseudocholinesterase. Prolonged paralysis has occurred 3 times in the past 2 years at this pediatric hospital after administration of mivacurium. The following case study describes causality and interventions for a patient with prolonged paralysis after receiving mivacurium.