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British Journal of Anaesthesia, 2004, Vol. 92, No. 2 289-293
© 2004 The Board of Management and Trustees of the British Journal of Anaesthesia

Case Reports

Acute motor axonal polyneuropathy after a cisatracurium infusion and concomitant corticosteroid therapy

V. Fodale*, C. Praticò, P. Girlanda, A. Baradello, T. Lucanto, C. Rodolico, C. Nicolosi, V. Rovere, L. B. Santamaria and R. Dattola

Section of Anesthesia and Intensive Care Unit, Department of Neuroscience, Psychiatric and Anesthesiological Sciences, University of Messina, Policlinico Universitario ‘G.Martino’, I-98125 Messina, Italy

*Corresponding author. E-mail: vfodale@unime.it

A 40-yr-old male was admitted to the intensive care unit following blunt chest trauma. He had multiple rib fractures, bilateral pneumothoraces, and acute respiratory failure requiring mechanical ventilation. Sedation was achieved with midazolam and morphine, and later with propofol. The patient was paralysed with a continuous infusion of cisatracurium 1.42–5.75 µg kg–1 min–1. Methylprednisolone 125 mg i.v. every 12 h was also started. After discontinuation of the cisatracurium infusion 7 days later, the patient manifested a flaccid quadriplegia with absence of deep-tendon reflexes. No sensory deficits were observed. Electromyography (EMG), repetitive nerve stimulation testing, and single fibre EMG (SFEMG) were performed at regular intervals after stopping cisatracurium. Clinical symptoms and electrophysiological examinations supported the diagnosis of acute motor axonal polyneuropathy related to concomitant administration of cisatracurium and corticosteroid therapy.

Br J Anaesth 2004; 92: 289–93


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