Resistance to rocuronium and cisatracurium in a patient with a spinal injury and acute respiratory distress syndrome

作者：Riley Kristina; Yampolsky Natalie^*; Hakma Zakaria; Moussouttas Michael

来源：American Journal of Health-System Pharmacy, 2015, 72(8): 632-635.

DOI：10.2146/ajhp140343

Purpose. A case of resistance to rocuroniurn and cisatracurium in,a patient with a spinal injury who developed acute respiratory distress syndrome (ARDS) is reported.
Summary. A 34-year-old, 88-kg Caucasian man with a history of polysubstance abuse fell from a bridge approximately 30-ft high, landing head first in about 2-3 ft of water. The patient sustained anterior subluxation at cervical spine levels C5-C6 and severe spinal canal compromise with cord compression and edema from C5 to C7, resulting in quadriplegia. The patient developed aspiration pneumonia for which he was given vancomycin and piperacillin-tazobactam. His pneumonia progressed to ARDS, and drug-induced paralysis was attempted to reduce barotrauma and improve ventilation. Rocuronium was initiated, but the patient did not adequately respond to this treatment. Cisatracurium was then initiated, but the patient did not respond. The decision was made to discontinue the cisatracurium infusion at that time and manage the patient's ARDS without a neuromuscular blocking agent (NMBA). After several attempts to manage the patient's ARDS by adjusting ventilatory values, the patient required the reinitiation of an NMBA. The decision was made to try cisatracurium again. Cisatracurium was again unsuccessful and therefore discontinued. As a last attempt to improve oxygenation, the patient received nitric oxide and sedation with propofol. The patient died due to his complicated hospital course that included quadriplegia, ARDS, cardiac arrest, and sepsis secondary to a gastric perforation.
Conclusion. Inadequate paralysis was achieved with rocuronium and cisatracurium in a patient who sustained a significant trauma resulting in quadriplegia.

• 出版日期2015-4-15