Marked prolongation of the succinylcholine effect two hours after neostigmine reversal of neuromuscular blockade in a patient with chronic renal insufficiency.

Prolonged neuromuscular blockade from succinylcholine after neostigmine administration has been reported in patients with frank renal failure. We present a case of prolonged neuromuscular blockade from succinylcholine administration, given 2 hours after neostigmine reversal of neuromuscular blockade in a patient with chronic renal insufficiency. This case shows that patients with chronic renal insufficiency, like patients with renal failure, are at risk for prolonged succinylcholine blockade if they have recently received anticholinesterase reversal of neuromuscular blockade. Administration of succinylcholine for facilitation of urgent endotracheal intubation may be required soon after reversal of nondepolarizing muscle relaxants, particularly in patients who return to the operating room for emergency care.