[Taiyakikung]

An adult patient is being treated with a parenteral aminoglycoside for a serious Pseudomonas aeruginosa infection. He requires immediate surgery. He is premedicated with midazolam. A dose of succinylcholine is given for intubation, with skeletal muscle paralysis maintain during surgery with nitrous oxide, isofluorane, and the oxygen. Which of the following is the most likely outcome of having the aminoglycoside "on board" in the perioperative setting along with all these drugs?

A. Acute hepatotoxicity from aminoglycoside-isoflurane interaction.
B. Antagonism of midazolam's amnestic and sedative effects.
C. Enhanced aminoglycoside toxicity to the host cell.
D. Increased or prolonged response to neuromuscular blocker.
E. Reduced risk of catecholamine-induced cardiac arrhythmia.

 

[mle2resident]

D is the answer. Use of aminoglycosides and general anesthetics can cause prolonged NM blockade and cause resp depression.

 

[aktorque]

Yes the ans is D) Increased or prolonged response to neuromuscular blocker.

According to this..

"The toxicities of aminoglycosides include nephrotoxicity, ototoxicity (vestibular and auditory) and, rarely, neuromuscular blockade and hypersensitivity reactions. Nephrotoxicity receives the most attention, perhaps because of easier documentation of reduced renal function, but it is usually reversible."

http://www.aafp.org/afp/981115ap/gonzalez.html

 

[JudithMos]

An adult patient is being treated with a parenteral aminoglycoside for a serious Pseudomonas aeruginosa infection. He requires immediate surgery. He is premedicated with midazolam. A dose of succinylcholine is given for intubation, with skeletal muscle paralysis maintain during surgery with nitrous oxide, isofluorane, and the oxygen. Which of the following is the most likely outcome of having the aminoglycoside "on board" in the perioperative setting along with all these drugs?

A. Acute hepatotoxicity from aminoglycoside-isoflurane interaction.
B. Antagonism of midazolam's amnestic and sedative effects.
C. Enhanced aminoglycoside toxicity to the host cell.
D. Increased or prolonged response to neuromuscular blocker.
E. Reduced risk of catecholamine-induced cardiac arrhythmia.

:notsure: My opinion - C. Enhanced aminoglycoside toxicity to the host cell.

Based on the article - Antibiotics for Aminoglycosides

 

[star123]

i'll go with d. its a rare effect.

 

[JudithMos]

I agree with you!