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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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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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