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Not only aminoglycoside .....also Colistin


The traditional text book of anesthesia tells us about the the interaction between aminoglycoside and the non depolarizing muscle relaxants...

 It is true ...the aminoglycoside prolong the action of muscle relaxants.....

 But it is not only o for aminoglycoside .....Colistin also...

 You may not be be familiar with Colistin...it highly used in many areas (Lebanon one of these countries)..

 Here is the Colistin issue and its implications on anesthesia practice..(report from the anesthesia safety news letter)
Colistin, otherwise known as Polymyxin E, is a drug seeing a resurgence in use against multi-drug-resistant Gram negative bacteria, in particular Acinetobacter, E-coli, Klebsiella, and P. aeruginosa.

  This drug, initially developed in the 1950s, was supplanted by the aminoglycosides because of the concern for significant nephrotoxicity and neurotoxicity associated with Polymyxin E.

 Of particular concern to anesthesiologists is the neuromuscular blockade due to non-competitive blockade. This blockade is independent of that caused by our common clinical neuromuscular blocking agents, known to accentuate such blockade, and not reversed by neostigmine.

Recently  case  report where an individual receiving Colistin to treat a multi-drug- resistant Acinetobacter required surgery and intuba- tion. Unaware of the implication of the antibiotic treatment, the anesthesiologist administered a small, 20-mg dose of rocuronium to facilitate intubation. This resulted in a very deep and prolonged period of neuromuscular blockade, requiring almost 24 hours before measurable evidence of spontaneous recovery 

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