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Prolonged onset and duration of action of rocuronium after accidental subcutaneous injection in a patient with chronic renal failure—a case report

BACKGROUND: Drugs administered subcutaneously have delayed onset and prolonged duration of action versus those given intravenously. Since the duration of action of rocuronium is prolonged in patients with renal dysfunction, subcutaneous administration of rocuronium to such patients might significant...

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Autores principales: Doshu-Kajiura, Akira, Suzuki, Junko, Suzuki, Takahiro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7914319/
https://www.ncbi.nlm.nih.gov/pubmed/33638714
http://dx.doi.org/10.1186/s40981-021-00421-3
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author Doshu-Kajiura, Akira
Suzuki, Junko
Suzuki, Takahiro
author_facet Doshu-Kajiura, Akira
Suzuki, Junko
Suzuki, Takahiro
author_sort Doshu-Kajiura, Akira
collection PubMed
description BACKGROUND: Drugs administered subcutaneously have delayed onset and prolonged duration of action versus those given intravenously. Since the duration of action of rocuronium is prolonged in patients with renal dysfunction, subcutaneous administration of rocuronium to such patients might significantly prolong its effect. CASE PRESENTATION: A 51-year-old female with chronic renal failure was accidentally administered 1.04 mg/kg rocuronium subcutaneously. Marked prolongation of onset and duration of action of rocuronium were detected on acceleromyography. Slow development of the neuromuscular block was still observed at 100 min after injection. Administration of 4.5 mg/kg sugammadex at 140 min after rocuronium injection facilitated recovery from a train-of-four (TOF) count of 2 to a TOF ratio of 100% within 5 min. No symptoms of postoperative recurarization and upper airway obstruction were observed. CONCLUSION: Neuromuscular monitoring is necessary to evaluate the progress and depth of neuromuscular block, particularly when rocuronium is inadvertently administered subcutaneously.
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spelling pubmed-79143192021-03-15 Prolonged onset and duration of action of rocuronium after accidental subcutaneous injection in a patient with chronic renal failure—a case report Doshu-Kajiura, Akira Suzuki, Junko Suzuki, Takahiro JA Clin Rep Case Report BACKGROUND: Drugs administered subcutaneously have delayed onset and prolonged duration of action versus those given intravenously. Since the duration of action of rocuronium is prolonged in patients with renal dysfunction, subcutaneous administration of rocuronium to such patients might significantly prolong its effect. CASE PRESENTATION: A 51-year-old female with chronic renal failure was accidentally administered 1.04 mg/kg rocuronium subcutaneously. Marked prolongation of onset and duration of action of rocuronium were detected on acceleromyography. Slow development of the neuromuscular block was still observed at 100 min after injection. Administration of 4.5 mg/kg sugammadex at 140 min after rocuronium injection facilitated recovery from a train-of-four (TOF) count of 2 to a TOF ratio of 100% within 5 min. No symptoms of postoperative recurarization and upper airway obstruction were observed. CONCLUSION: Neuromuscular monitoring is necessary to evaluate the progress and depth of neuromuscular block, particularly when rocuronium is inadvertently administered subcutaneously. Springer Berlin Heidelberg 2021-02-27 /pmc/articles/PMC7914319/ /pubmed/33638714 http://dx.doi.org/10.1186/s40981-021-00421-3 Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Case Report
Doshu-Kajiura, Akira
Suzuki, Junko
Suzuki, Takahiro
Prolonged onset and duration of action of rocuronium after accidental subcutaneous injection in a patient with chronic renal failure—a case report
title Prolonged onset and duration of action of rocuronium after accidental subcutaneous injection in a patient with chronic renal failure—a case report
title_full Prolonged onset and duration of action of rocuronium after accidental subcutaneous injection in a patient with chronic renal failure—a case report
title_fullStr Prolonged onset and duration of action of rocuronium after accidental subcutaneous injection in a patient with chronic renal failure—a case report
title_full_unstemmed Prolonged onset and duration of action of rocuronium after accidental subcutaneous injection in a patient with chronic renal failure—a case report
title_short Prolonged onset and duration of action of rocuronium after accidental subcutaneous injection in a patient with chronic renal failure—a case report
title_sort prolonged onset and duration of action of rocuronium after accidental subcutaneous injection in a patient with chronic renal failure—a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7914319/
https://www.ncbi.nlm.nih.gov/pubmed/33638714
http://dx.doi.org/10.1186/s40981-021-00421-3
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