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

paythelady.612 shared this article with you from Inoreader Donepezil-related inadequate neuromuscular blockade during laparoscopic surgery: A case report. Μέσω pubmed: "world j clin cases"... Related Articles Donepezil-related inadequate neuromuscular blockade during laparoscopic surgery: A case report. World J Clin Cases. 2020 Nov 06;8(21):5341-5346 Authors: Jang EA, Kim TY, Jung EG, Jeong S, Bae HB, Lee S Abstract 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. PMID: 33269268 [PubMed] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.