Polypeptide Antibiotic Potentiation of Neuromuscular Blocking Agent Postoperatively: A Case Report

  • Jenna Reeve, DNP, CRNA

Abstract

During multiple surgical procedures, neuromuscular blocking agents (NMBAs) are administered as part of a general anesthetic to provide muscle relaxation. Examples of commonly administered NMBAs are succinylcholine, rocuronium, vecuronium, and cisatracurium. Administration of other medications during the surgical procedure can cause unexpected interactions, such as affecting the action of the NMBAs. The polypeptide class of antibiotics has been identified as one group of antibiotics that can potentiate NMBAs when administered during the perioperative period. Although the incidence of antibiotic-induced neuromuscular blockade is rare, it is important to be aware of this medication interaction and to know how to manage this potential complication. This report presents one such case with a review of the literature.

Author Biography

Jenna Reeve, DNP, CRNA
Texas Christian University.  Dr Reeve was a student at time of writing the manuscript

References

Kronenfeld MA, Thomas SJ, Turndorf H. Recurrence of neuromuscular blockade after reversal of vecuronium in a patient receiving polymyxin/amikacin sternal irrigation. Anesthesiology. 1986; 65(1): 93-94.
Durant NN, Lambert JJ. The action of polymyxin B at the frog neuromuscular junction. Br J Pharmacol. 1981; 72(1): 41-47.
Lee C, Chen D, Nagel EL. Neuromuscular block by antibiotics: polymyxin b. Anesth Analg. 1977; 56(3): 373-377.
Singh YN, Marshall IG, Harvey AL. Pre- and postjunctional blocking effects of aminoglycoside, polymyxin, tetracycline, and lincosamide antibiotics. Br J Anaesth. 1982; 54 (12): 1295-1306.
Fiekers JF. Neuromuscular block produced by polymyxin B: interaction with end-plate channels. Eur J Pharmacol. 1981; 70(1): 77-81.
Van Nyhuis LS, Miller RD, Fogdall RP. The interaction between d-tubocurarine, pancuronium, polymyxin B, and neostigmine on neuromuscular function. Anesth Analg. 1976; 55(2): 224-8.
Fogdall RP, Miller RD. Prolongation of a pancuronium-induced neuromuscular blockade by polymyxin B. Anesthesiology. 1974; 40(1): 84-87.
Kasiakou SK. Toxicity of polymyxins: a systematic review of the evidence from old and recent studies. Critical Care. 2006; 10: 1-13. doi:10.1186/cc3995
Lindesmith LA, Baines RD Jr, Bigelow DB, Petty TL. Reversible respiratory paralysis associated with polymyxin therapy. Ann Intern Med. 1968; 68(2): 318-327.
Sobek V. Arrest of respiration induced by polypeptide antibiotics. Arzneimittelforschung. 1982; 32(3): 235-237.
Pittinger C, Adamson R. Antibiotic blockade of neuromuscular function. Annu Rev Pharmacol 1972; 12: 169-184.
Burkett L, Bikhazi GB, Thomas KC, Rosenthal DA, Wirta MG, Foldes FF. Mutual potentiation of the neuromuscular effects of antibiotics and relaxants. Anesth Analg. 1979; 58: 107-115.
Hasfurther DL, Bailey PL. Failure of neuromuscular blockade reversal after rocuronium in a patient who received oral neomycin. Can J Anaesth. 1996; 43(6):617-620.
Brull SJ, Murphy GS. Residual neuromuscular block: lessons unlearned. part II: methods to reduce the risk of residual weakness. Anesth Analg. 2010; 111(1): 129-140.
Published
2016-05-13
How to Cite
REEVE, DNP, CRNA, Jenna. Polypeptide Antibiotic Potentiation of Neuromuscular Blocking Agent Postoperatively: A Case Report. Anesthesia eJournal, [S.l.], v. 4, n. 1, may 2016. ISSN 2333-2611. Available at: <http://www.anesthesiaejournal.com/index.php/aej/article/view/53>. Date accessed: 13 dec. 2018.
Section
Articles