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

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World Journal of Clinical Cases 2022年第35期10卷 13138-13145页

作者： Hao-Chen Wang Cheng-Wei Lu Tzu-Yu Lin Ya-Ying Chang Department of Anesthesiology Far-Eastern Memorial HospitalNew Taipei City 220Taiwan Department of Mechanical Engineering Yuan Ze UniversityChung-Li 320Taiwan International Program in Engineering for Bachelor Yuan Ze UniversityChung-Li 320Taiwan

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.

关键词： Sugammadex Train-of-four Rocuronium neuromuscular blockade General anesthesia Case report

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Sugammadex is associated with better respiratory recovery than neostigmine following reversal of anaesthesia-associated neuromuscular blockade in the morbidly obese patients following elective laparoscopic surgery

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Laparoscopic, Endoscopic and Robotic Surgery 2018年第2期1卷 33-36页

作者： M.Johnson O.A.Khan E.R.McGlone A.A.Roman J.S.Qureshi A.Kayal Anaesthetic Registrar St Helier HospitalWrythe LaneSM51AAUK St Georges NHS Trust LondonSW17 OQTUK

Complete and reliable neuromuscular reversal is important to successful anaesthetic recovery in the morbidly obese patient undergoing laparoscopic *** goal was to determine whether sugammadex,a selective reversal agent is associated with better respiratory recovery than neostigmine following the reversal of anaesthesia-associated neuromuscular blockade by rocuronium in the morbidly *** Expiratory Flow Rate a surrogate marker for respiratory function,was the primary outcome measured and secondary outcome measures included post-operative nausea and vomiting,pain and head *** found that patients reversed with sugammadex had a significantly higher post-operative PEFR as compared to those reversed with neostigmine and glycopyrrolate group.

关键词： Sugammadex Laparoscopic surgery neuromuscular blockade Morbidly obese

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Electromyographic monitoring of facial nerve under different levels of neuromuscular blockade during middle ear microsurgery

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Chinese Medical Journal 2009年第3期122卷 311-314页

作者： CAI Yi-rong XU Jing CHEN Lian-hua CHI Fang-lu Department of Anesthesiology Eye Ear Nose and Throat Hospital Fudan University Shanghai 200031 China Department of Otolaryngology Eye Ear Nose and Throat Hospital Fudan University Shanghai 200031 China

Background The evoked electromyography （EMG） is frequently used to identify facial nerve in order to prevent its damage during surgeries. Partial neuromuscular blockade （NMB） has been suggested to favor EMG activity and insure patients＇ safety. The aim of this study was to determine an adequate level of NMB correspondent to sensible facial nerve identification by evaluating the relationship between facial EMG responses and peripheral NMB levels during the middle ear surgeries. Methods Facial nerve evoked EMG and NMB monitoring were performed simultaneously in 40 patients who underwent tympanoplasty. Facial electromyographic responses were recorded by insertion of needle electrodes into the orbicularis otis and orbicularis oculi muscles after electrical stimulation on facial nerve. The NMB was observed objectively with the hypothenar muscle＇s twitching after electrical stimulation of ulnar nerve, and the intensity of blockade was adjusted at levels of 0, 25%, 50%, 75%, 90%, and 100% respectively with increased intravenous infusion of Rocuronium （muscle relaxant）. Results All of the patients had detectable EMG responses at the levels of NMB 〈50%. Four out of forty patients had no EMG response at the levels of NMB 〉75%. A significant linear positive correlation was present between stimulation thresholds and NMB levels while a linear negative correlation was present between EMG amplitudes and NMB levels. Conclusions The facial nerve monitoring via facial electromyographic responses can be obtained when an intraoperative partial neuromuscular blockade is induced to provide an adequate immobilization of the patient. The 50% NMB should be considered as the choice of anesthetic management for facial nerve monitoring in otologic microsurgery based on the relationship of correlation.

关键词： neuromuscular blockade facial nerve evoked electromyography

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The Safe Use of Sugammadex “Rescue” after Neostigmine: 2 Case Reports

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Open Journal of Anesthesiology 2016年第9期6卷 125-127页

作者： Joseph F. Answine Pinnacle Health Hospitals Harrisburg PA USA Department of Anesthesiology Pennsylvania State University Hospital Hershey PA USA

With the introduction of the rocuronium and vecuronium binding agent sugammadex into clinical practice in the United States, its use for reversal of neuromuscular blockade will likely start in some institutions as a “rescue” after failed reversal with neostigmine. However, sugammadex after neostigmine has not been extensively studied. Therefore, there is a question as to its effectiveness when used in this way especially in the airway compromised patients that the anesthesia provider will commonly face in this situation. Furthermore, there is a possibility of hemodynamic compromise. These two case reports demonstrate the safe and effective use of sugammadex after failed reversal with neostigmine.

关键词： Sugammadex Neostigmine Reversal Airway Hemodynamics Rocuronium Vecuronium neuromuscular blockade Nicotinic Weakness Bradycardia Train-of-Four

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