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ANESTHETIC PHARMACOLOGY

Prolongation of Rapacuronium Neuromuscular Blockade by Clindamycin and Magnesium

University of Kentucky College of Medicine, Lexington, Kentucky

Address correspondence to Paul A. Sloan, MD, Department of Anesthesiology, University of Kentucky Hospital, 800 Rose Street, Lexington, KY 40536. Address e-mail to PaulSloan{at}prodigy.net

Rapacuronium was developed as an ultra-short acting nondepolarizing neuromuscular blocker allowing tracheal intubation at 90 s, yet still permitting reversal at a mean of 14 min after administering an intubating dose (1). The duration of blockade is slightly prolonged by the use of inhaled anesthetics, aminoglycosides, clindamycin, magnesium, and pregnancy (2). In general, the effect of rapacuronium is only prolonged by a few minutes in parturients (3).

The purpose of this report is to record the first rapacuronium neuromuscular block significantly prolonged by concomitant clindamycin and magnesium when rapacuronium was used to facilitate general endotracheal anesthesia in a patient for emergency cesarean delivery.

IMPLICATIONS: We report a prolonged neuromuscular block with the nondepolarizing muscle relaxant rapacuronium in the presence of clindamycin. Even when using "short-acting" muscle relaxants, the anesthesiologist must routinely monitor the neuromuscular function.