Lithium carbonate is a medication used for the management of various mental disorders. The present report describes a case of prolongation of rocuronium bromide in a patient concurrently taking lithium carbonate. A 64-year-old woman was scheduled to undergo cystectomy under general anesthesia. The patient took lithium carbonate (600 mg/d) for treatment of bipolar affective disorder. General anesthesia was induced with propofol, fentanyl, remifentanil, and sevoflurane. After loss of consciousness, rocuronium bromide (50 mg) was administered, and the trachea was intubated. Approximately 1 hour after the administration of rocuronium, the degree of residual muscle relaxant was evaluated using a nerve stimulation device. No muscle contraction occurred with train-of-four (TOF) stimulation. Following administration of sugammadex (200 mg) the TOF ratio increased to 95%. The ionic size of lithium is similar to that of sodium; therefore, lithium is transported into the cell with sodium. The resting membrane potential decreases, leading to a reduction in the height of the action potential. Thus, the effect of the remaining lithium may have been superimposed on the rocuronium neuromuscular blockade. Evaluation with a nerve stimulation device in patients taking lithium is crucial before extubation because of the risk of rocuronium potentiation.
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Fall 2020
case report|
September 29 2020
Potentiation of Rocuronium Bromide by Lithium Carbonate: A Case Report
Naotaka Kishimoto, DDS, PhD;
Division of Dental Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8514, Japan
Address correspondence to Dr Naotaka Kishimoto, Division of Dental Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, 2-5274, Gakkocho-dori, Chuo-ku, Niigata 951-8514, Japan; kishimoto@dent.niigata-u.ac.jp
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Hiroyuki Yoshikawa, DDS, PhD;
Hiroyuki Yoshikawa, DDS, PhD
Division of Dental Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8514, Japan
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Kenji Seo, DDS, PhD
Kenji Seo, DDS, PhD
Division of Dental Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8514, Japan
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Anesth Prog (2020) 67 (3): 146–150.
Article history
Received:
December 05 2018
Accepted:
August 06 2019
Citation
Naotaka Kishimoto, Hiroyuki Yoshikawa, Kenji Seo; Potentiation of Rocuronium Bromide by Lithium Carbonate: A Case Report. Anesth Prog 1 September 2020; 67 (3): 146–150. doi: https://doi.org/10.2344/anpr-66-04-04
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