. 2014 Dec 4;62(3):304–318. doi: 10.1007/s12630-014-0286-7

Table 4.

Perioperative considerations for patients on quinine therapy

Effect	Mechanism	Management strategy
Hypoglycemia (may be profound in children and pregnancy)	Quinine is a potent stimulator of pancreatic insulin release	Regular blood glucose monitoring is essential and should be performed with any decrease in level of consciousness or convulsions. Consider continuous intravenous dextrose infusion to prevent hypoglycemia.
Cardiac arrhythmia (may be life-threatening in elderly or those with cardiovascular disease)80	Quinine blocks cardiac fast Na⁺ channels prolonging action potential duration and repolarization time	A baseline electrocardiogram and continuous cardiac monitoring to exclude lengthening of the QT interval is essential in patients receiving intravenous quinine therapy.
Prolonged neuromuscular blockade81	Quinine affects neuromuscular transmission presynaptically by blocking voltage-gated Na⁺ channels and postsynaptically by potentiating depolarization. The overall effect is to reduce motor end-plate excitability.	Monitor depth of neuromuscular blockade with nerve stimulator to ensure full reversal prior to extubation. Prolonged neuromuscular blockade may necessitate postoperative ventilation until full resolution of blockade.

Effect

Mechanism

Management strategy

Hypoglycemia (may be profound in children and pregnancy)

Quinine is a potent stimulator of pancreatic insulin release

Regular blood glucose monitoring is essential and should be performed with any decrease in level of consciousness or convulsions.

Consider continuous intravenous dextrose infusion to prevent hypoglycemia.

Cardiac arrhythmia (may be life-threatening in elderly or those with cardiovascular disease)80

Quinine blocks cardiac fast Na⁺ channels prolonging action potential duration and repolarization time

A baseline electrocardiogram and continuous cardiac monitoring to exclude lengthening of the QT interval is essential in patients receiving intravenous quinine therapy.

Prolonged neuromuscular blockade81

Quinine affects neuromuscular transmission presynaptically by blocking voltage-gated Na⁺ channels and postsynaptically by potentiating depolarization. The overall effect is to reduce motor end-plate excitability.

Monitor depth of neuromuscular blockade with nerve stimulator to ensure full reversal prior to extubation. Prolonged neuromuscular blockade may necessitate postoperative ventilation until full resolution of blockade.