PROLONGED PARESIS FOLLOWING GALLAMINE A Case Report BY

A case of prolonged muscular paresis is reported following the administration of 120 mg of gallamine triethiodide to a patient who developed anuria. The muscular weakness con-tinued for five days, necessitating artificial ventilation; it was finally reversed by haemo-dialysis. It is probable that the neuromuscular weakness was accentuated by the effects of a low extracellular potassium concentration and by streptomycin. The duration of action of the muscle relaxants depends upon the efficacy of redistribution, excretion and metabolic destruction in lowering the circulating concentration of the drug below that level required to produce a clinical effect. The plasma level of muscle relaxant required to cause a neuromuscular block is influenced by many factors including patient sensitivity,, potassium depletion and the presence of synergistic drugs. The patient described in this case report developed muscular paresis postoperatively, re-quiring assisted ventilation for five days following a single dose of 120 mg gallamine triethiodide. It is probable that the prolonged action of the muscle relaxant was due to a combination of factors: (1) A failure to excrete the drug. (2) A low extracellular potassium. (3) The synergistic effect of an accumulation of streptomycin. (4) A possible altered response by the patient to gallamine. CASE REPORT The patient was a 37-year-old female Spanish domestic worker who had recently arrived in this country and who spoke no English