Prolonged Neuromuscular Block Due to DrugDrug Interaction in a Post-Chemotherapy Patient Posted for Septoplasty: A Case Report

Authors

  • Chashamjotbawa Assistant prof/ dept of anaesthesiology/ maharishi markandeshwar institute of medical sciences and research/ maharishi markandeshwar deemed university/ mullana/ ambala/ haryana/india Postal address- sabharwal children hospital, police lines crossing, ambala city 134003(haryana) Author
  • Amandeepsingh Assistant prof/ dept of anaesthesiology/ maharishi markandeshwar institute of medical sciences and research/ maharishi markandeshwar deemed university/ mullana/ ambala/ haryana/ india Corresponding author, postal address- house no. 142, sector 11a, chandigarh 160011(u.t.) Author
  • Laveenadabla P.g. Resident/ dept of anaesthesiology/ maharishi markandeshwar institute of medical sciences and research/ maharishi markandeshwar deemed university/ mullana/ ambala/ haryana/ india Postal address- bhiwani link road near gourav ice factory charkhidadri, disttcharkhidadri, haryana 127306 Author

DOI:

https://doi.org/10.61841/yazs7154

Keywords:

chemotherapy, cyclophosphamide induced pseudocholinesterase deficiency, succinylcholine, delayed recovery, drug-drug interactions

Abstract

Introduction- It is not uncommon to encounter cancer patients who have been subjected to chemotherapy being planned for non-oncological surgery. Chemotherapeutic drugs stimulate a cascade of catastrophic events leading to apoptosis via drug-receptor interaction. We are presenting a case report on one such side-effect missed on the pre-operative assessment that led to prolonged recovery phase in a patient posted for septoplasty under general anesthesia.

Case Report: A 62-year-old female planned for septoplasty had been on chemotherapeutic treatment for unilateral breast cancer stage 2. Drug-related toxicities were ruled out, and general anesthesia was planned. Premedication in the form of injection glycopyrrolate 0.005 mg/kg and fentanyl 1 microgram/kg; induction by injection propofol (total 90 mg); and succinylcholine 1.5 mg/kg. After securing ETT, maintenance was achieved with isoflurane and N20:O2 (50:50) with vecuronium used as NDMR. Post-cessation of surgery, which lasted for 1 hour 40 minutes, inhalational gases were stopped, but the patient remained deeply sedated and hypotonic despite reversal with neostigmine for 45 minutes. Thereafter, her eye opening returned, but her tachypnoea persisted, so she was bridged to BiPAP mode in the ICU till she regained muscle tone and distress subsided, which took around 2 hours. This delayed muscular recovery was thought to be due to cyclophosphamide-induced pseudocholinesterase inhibition, which caused the action of succinylcholine to be prolonged.

Conclusion: Chemotherapeutic agents and their drug-drug interactions must be kept in mind while formulating plans of anesthesia for cancer patients undergoing surgery for general indications. 

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Published

30.04.2020

Issue

Vol. 24 No. 2 (2020): 24 (2) 2020

Section

Articles

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How to Cite

Chashamjotbawa, Amandeepsingh, & Laveenadabla. (2020). Prolonged Neuromuscular Block Due to DrugDrug Interaction in a Post-Chemotherapy Patient Posted for Septoplasty: A Case Report. International Journal of Psychosocial Rehabilitation, 24(2), 1519-1526. https://doi.org/10.61841/yazs7154