Nueromuscular blockade

Though rare, a curare-like block may occur at high doses of aminoglycosides and may result in respiratory paralysis. This side effect most often occurs after direct intraperitoneal or intrapleural application of large doses of aminoglycosides. The mechanism responsible is a decrease in both the release of acetylcholine from prejunctional nerve endings and the sensitivity of the postsynaptic site. Patients with myasthenia gravis are particularly at risk. Prompt administration of calcium gluconate or neostigmine can reverse the block that causes neuromuscular paralysis but ventilatory support may be required.