An elderly male on ventilator has received atracurium infusion for 3 days. He now develops epileptic fits. Probable cause for his epilepsy is:
Correct Answer: Accumulation of Laudanosine
Description: (C) Accumulation of Laudanosine [Lee13-191; Wuer-b09, 831# Laudanosine is a metabolite of Atracurium and has CNS stimulating properties.> Laudanosine may produce convulsions from its CNS stimulating action, when high plasma concentration of Laudanosine are reached. In clinical practice, in the operating room and ICV setting, such high concentrations are usually not reached, out the patient in question has been on atracurium for 3 consecutive days before he develops epilepsy and hence high plasma concentration of Laudanosine could well be a probable cause for epilepsy.# Use Of Muscle Relaxants In The Intensive Care Unit:> Canadian Journal Of Anaesthesia : Laudanosine is a metabolite of Atracurium. Hofmann elimination of each molecule of Atracurium releases two molecules of laudanosine. Laudanosine is a central system stimulant and has caused seizures in dogs following large intravenous boluses The seizure threshold level in humans is not known but case reports suggest that clinical doses are unlikely to result in important central effects in humans. Hepatic clearance and elimination half- life are prolonged in patients with liver failure. (Renal elimination accounts for only 4-9% while the remaining portion is dependent upon hepatic metabolism).
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Anaesthesia
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