LETTER
Prolonged Weakness and Vecuronium
Dana Bernstein
1 April 1993 | Volume 118 Issue 7 | Pages 569-571
TO THE EDITOR:
The recent article by Kupfer and colleagues [1] describes prolonged weakness in 5 of 10 patients who received long-term therapy with vecuronium. In none of these cases, however, was the dose of vecuronium given in mg/kg per day. Four of the ten patients received average doses between 6.7 and 12 mg/h—unusually high doses.
Metabolites of vecuronium may play a role in prolonged paralysis. The metabolite 3-desacetylvecuronium has neuromuscular blocking activity in feline models [2]. Segredo and colleagues [3] showed an association between high levels of this metabolite and prolonged paralysis. In their study, patients without prolonged paralysis received a median vecuronium infusion rate of 0.35 µg/kg per min (range, 0.1 to 0.8 µg/kg per min) [3].
Higher infusion rates of vecuronium may explain the degree of prolonged neuromuscular blockade noted.
1. Kupfer Y, Namba T, Kaldawi E, Tessler S. Prolonged weakness after long-term infusion of vecuronium bromide. Ann Intern Med. 1992; 117:484-6.
2. Bencini AF, Houwertjes MC, Agoston S. Effects of hepatic uptake of vecuronium bromide and its putative metabolites on the neuromuscular blocking actions in the cat. Br J Anaesth. 1985; 57:789-95.
3. Segredo V, Caldwell JE, Matthay MA, Sharma ML, Gruenke LD, Miller RD. Persistent paralysis in critically ill patients after long-term administration of vecuronium. N Engl J Med. 1992; 327:524-8.
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