Unexpected delayed reversal of rocuronium-induced neuromuscular blockade by sugammadex:A case report and review of literature

作     者：Hao-Chen Wang Cheng-Wei Lu Tzu-Yu Lin Ya-Ying Chang 

作者机构：Department of AnesthesiologyFar-Eastern Memorial HospitalNew Taipei City 220Taiwan Department of Mechanical EngineeringYuan Ze UniversityChung-Li 320Taiwan International Program in Engineering for BachelorYuan Ze UniversityChung-Li 320Taiwan 

出 版 物：《World Journal of Clinical Cases》 (世界临床病例杂志)

年 卷 期：2022年第10卷第35期

页      面：13138-13145页

核心收录：

学科分类：1002[医学-临床医学] 100217[医学-麻醉学] 10[医学] 

基　　金：Far-Eastern Memorial Hospital No.FEMH-2022-C-057 

主　　题：Sugammadex Train-of-four Rocuronium Neuromuscular blockade General anesthesia Case report 

摘      要：BACKGROUND Rocuronium,a nondepolarizing muscle relaxant,is usually administered during general anesthesia to facilitate endotracheal intubation and keep patients immobile during the ***,the selective reversal agent of rocuronium,fully reverses the neuromuscular blockade(NMB)at the end of *** reports show that sugammadex rapidly achieves a ratio of train-offour(TOF),a quantitative method of neuromuscular monitoring,of 0.9 which ensures adequate recovery for safe ***,very rare patients with neuromuscular diseases may respond poorly to *** SUMMARY A 69-year-old female presented with abdominal fullness and nausea,and was diagnosed with *** underwent gastric peroral endoscopic myotomy under general anesthesia with rocuronium(0.7 mg/kg).At the end of surgery,sugammadex 3.6 mg/kg was administered when TOF showed 2 ***,the TOF ratio recovered to 0.65 in 30 *** was awake but could not fully open her *** tidal volume during spontaneous breathing was *** additional doses of sugammadex(up to 7.3 mg/kg)in the following 3 h,the TOF ratio was 0.9,and the endotracheal tube was smoothly *** excluding possible mechanisms underlying the prolonged recovery course,we speculated our patient may have had an undiagnosed neuromuscular disease,hinted by her involuntary movement of the tongue and ***,her poor renal function and history of delayed recovery from general anesthesia may be related to the long duration of *** In our case,both prolonged rocuronium-induced NMB and poor response to sugammadex were *** optimize the dose of rocuronium,perioperative TOF combined with other neuromuscular monitoring is suggested.