A 60-kg woman sustained second- and third-degree burns over 50 percent of her body 10 days ago. She is brought to the operating room for an exploratory laparotomy. After an initial dose of 6 mg of vecuronium, she requires additional neuromuscular relaxant within 15 minutes to maintain abdominal relaxation. The MOST likely explanation for this observation is the presence of:
Resistance develops to all nondepolarizing muscle relaxants in patients with burns greater than 30 percent of total body surface area. This phenomenon begins approximately one week and peaks five to six weeks after injury. Upregulation of acetylcholine receptors is the predominant cause of nondepolarizing muscle relaxant resistance and has been documented following thermal injury.
A severe burn produces systemic effects that stimulate the release of mediators into the circulation, causing immune suppression, hypermetabolism, protein catabolism, sepsis, and multisystem organ failure. Immediately after a burn, microvascular permeability increases for three to...
