A noninvasive method in the differential diagnosis of vecuronium-induced and magnesium-induced protracted neuromuscular block in a severely preeclamptic patient

Abstract The occurrence of neuromuscular blockade and the resulting potentiation of muscle relaxants during magnesium sulfate (MgSO 4 ) administration is well known. However, a method to differentiate the neuromuscular block induced by magnesium from that induced by curariform nondepolarizing muscle relaxant in the clinical setting has never been reported. We report a case in which the duration of action of 1 mg of vecuronium lasted 4 hours in a patient with severe preeclampsia whose serum magnesium level was in the therapeutic range. We believe this is a remarkable potentiation on record in the literature. We also describe a new, noninvasive method to assess magnesium-induced neuromuscular block when curariform muscle relaxant was given simultaneously.