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Prolonged Weakness and Vecuronium
- Dana Bernstein, MD
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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/hunusually 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 g/kg per min (range, 0.1 to 0.8 g/kg per min) [3].
Higher infusion rates of vecuronium may explain the degree of prolonged neuromuscular blockade noted.
Dana Bernstein
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
Include no more than 300 words of text, three authors, and five references
Type with double-spacing
Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright 2004 by the American College of Physicians
