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Donepezil-related inadequate neuromuscular blockade during laparoscopic surgery: A case report

BACKGROUND: Donepezil is an acetylcholinesterase inhibitor used to improve cognition and delay disease progression in dementia patients by increasing acetylcholine levels. This drug may potentially interact with neuromuscular blocking agents (NMBAs) that act on muscular acetylcholine receptors durin...

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Autores principales: Jang, Eun-A, Kim, Tae-Young, Jung, Eu-Gene, Jeong, Seongtae, Bae, Hong-Beom, Lee, Seongheon
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7674726/
https://www.ncbi.nlm.nih.gov/pubmed/33269268
http://dx.doi.org/10.12998/wjcc.v8.i21.5341
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author Jang, Eun-A
Kim, Tae-Young
Jung, Eu-Gene
Jeong, Seongtae
Bae, Hong-Beom
Lee, Seongheon
author_facet Jang, Eun-A
Kim, Tae-Young
Jung, Eu-Gene
Jeong, Seongtae
Bae, Hong-Beom
Lee, Seongheon
author_sort Jang, Eun-A
collection PubMed
description BACKGROUND: Donepezil is an acetylcholinesterase inhibitor used to improve cognition and delay disease progression in dementia patients by increasing acetylcholine levels. This drug may potentially interact with neuromuscular blocking agents (NMBAs) that act on muscular acetylcholine receptors during general anesthesia. Herein, we present a case of inadequate neuromuscular blockade with rocuronium, a nondepolarizing NMBA, in a dementia patient who had taken donepezil. CASE SUMMARY: A 71-year-old man was scheduled for laparoscopic gastrectomy. He had been taking donepezil 5 mg for dementia. General anesthesia was induced with propofol and remifentanil. The depth of neuromuscular blockade was monitored by train-of-four (TOF) stimulation. After the administration of rocuronium, the TOF ratio decreased at an unusually slow rate, and a TOF count of 0 was detected 7 min later. After intubation, a TOF count of 1 was detected within 1 min, and a TOF ratio of 12% was detected within 2 min. The TOF count remained at 4 even with an additional bolus and continuous infusion of rocuronium, suggesting resistance to this NMBA. Instead of propofol, an inhalation anesthetic was administered alongside another NMBA (cisatracurium). Then, the quality of neuromuscular blockade improved, and the TOF count remained at 0-1 for the next 70 min. No further problems were encountered with respect to surgery or anesthesia. CONCLUSION: Donepezil may be responsible for inadequate neuromuscular blockade during anesthesia, especially when total intravenous anesthesia is used.
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spelling pubmed-76747262020-12-01 Donepezil-related inadequate neuromuscular blockade during laparoscopic surgery: A case report Jang, Eun-A Kim, Tae-Young Jung, Eu-Gene Jeong, Seongtae Bae, Hong-Beom Lee, Seongheon World J Clin Cases Case Report BACKGROUND: Donepezil is an acetylcholinesterase inhibitor used to improve cognition and delay disease progression in dementia patients by increasing acetylcholine levels. This drug may potentially interact with neuromuscular blocking agents (NMBAs) that act on muscular acetylcholine receptors during general anesthesia. Herein, we present a case of inadequate neuromuscular blockade with rocuronium, a nondepolarizing NMBA, in a dementia patient who had taken donepezil. CASE SUMMARY: A 71-year-old man was scheduled for laparoscopic gastrectomy. He had been taking donepezil 5 mg for dementia. General anesthesia was induced with propofol and remifentanil. The depth of neuromuscular blockade was monitored by train-of-four (TOF) stimulation. After the administration of rocuronium, the TOF ratio decreased at an unusually slow rate, and a TOF count of 0 was detected 7 min later. After intubation, a TOF count of 1 was detected within 1 min, and a TOF ratio of 12% was detected within 2 min. The TOF count remained at 4 even with an additional bolus and continuous infusion of rocuronium, suggesting resistance to this NMBA. Instead of propofol, an inhalation anesthetic was administered alongside another NMBA (cisatracurium). Then, the quality of neuromuscular blockade improved, and the TOF count remained at 0-1 for the next 70 min. No further problems were encountered with respect to surgery or anesthesia. CONCLUSION: Donepezil may be responsible for inadequate neuromuscular blockade during anesthesia, especially when total intravenous anesthesia is used. Baishideng Publishing Group Inc 2020-11-06 2020-11-06 /pmc/articles/PMC7674726/ /pubmed/33269268 http://dx.doi.org/10.12998/wjcc.v8.i21.5341 Text en ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
spellingShingle Case Report
Jang, Eun-A
Kim, Tae-Young
Jung, Eu-Gene
Jeong, Seongtae
Bae, Hong-Beom
Lee, Seongheon
Donepezil-related inadequate neuromuscular blockade during laparoscopic surgery: A case report
title Donepezil-related inadequate neuromuscular blockade during laparoscopic surgery: A case report
title_full Donepezil-related inadequate neuromuscular blockade during laparoscopic surgery: A case report
title_fullStr Donepezil-related inadequate neuromuscular blockade during laparoscopic surgery: A case report
title_full_unstemmed Donepezil-related inadequate neuromuscular blockade during laparoscopic surgery: A case report
title_short Donepezil-related inadequate neuromuscular blockade during laparoscopic surgery: A case report
title_sort donepezil-related inadequate neuromuscular blockade during laparoscopic surgery: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7674726/
https://www.ncbi.nlm.nih.gov/pubmed/33269268
http://dx.doi.org/10.12998/wjcc.v8.i21.5341
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