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Prolonged Weakness and Vecuronium
- Victor L. Scott, MD;
- Judith A. Freeman, MD; and
- Andre M. DeWolf, MD
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TO THE EDITOR:
We agree with Kupfer and colleagues' [1] comments about the necessity of monitoring neuromuscular transmission and feel that this prospective study would have been enhanced by titrating the dose of vecuronium to a monitored end point, thereby excluding the possibility of overdose as a cause for prolonged paralysis, as probably occurred in Patients 3 and 10. In addition, the 3-desacetylvecuronium metabolite is approximately 50% to 60% as potent as the parent compound and accumulates in the presence of hepatic and renal insufficiency [2]. Had the authors measured serum levels of both vecuronium and its metabolite, they might have been able to show more clearly an association between the residual drug or its metabolite and prolonged neuromuscular blockade.
Several reports in the literature [3, 4] have documented the development of polyneuropathy and myopathy in patients receiving both steroids, especially methylprednisolone, and prolonged infusions or multiple bolus doses of nondepolarizing neuromuscular blocking agents. Muscle biopsies have shown a myopathy, with type II muscle fiber atrophy, as well as a neuropathy [5]. Our reading of the patient presentations (for example, Patient 5) suggest that both a polyneuropathy and myopathy were present.
No studies to date have documented vecuronium or other muscle relaxants as the cause of demyelination or myopathy, when administered without steroids.
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 Unpublished letters cannot be returned.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
