Reversal of prolonged rocuronium neuromuscular blockade with sugammadex in an obstetric patient with transverse myelitis

International Journal of Obstetric Anesthesia
G WeekesM Bowen

Abstract

A 38-year-old wheelchair-bound primigravida with transverse myelitis presented at 38 weeks of gestation for elective caesarean section. Transverse myelitis, which is characterised by bilateral inflammation of the spinal cord and myelin destruction, is associated with myopathy, autonomic dysreflexia and pulmonary aspiration. Regional anaesthesia was contraindicated in this case as the patient had undergone two previous lumbar spinal fusion procedures. Rocuronium 1.2 mg/kg was used to facilitate rapid intubating conditions. The caesarean section proceeded uneventfully, but even after administration of neostigmine the patient exhibited prolonged neuromuscular blockade. After 3 h and 15 min sugammadex was obtained to reverse neuromuscular blockade; the drug was not stocked in our hospital. Sugammadex 4 mg/kg resulted in complete reversal of blockade after 2 min. We believe that myopathy associated with transverse myelitis led to the prolonged duration of action of rocuronium. Sugammadex is a relatively new drug with few reported side effects. In this case it was used to reverse neuromuscular blockade and prevented prolonged postoperative ventilatory support.

References

Sep 1, 1994·British Journal of Anaesthesia·E AbouleishK Alford
Feb 1, 1997·Anesthesia and Analgesia·F K PühringerA Benzer
Feb 22, 2007·Anesthesia and Analgesia·Mohamed Naguib
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Feb 19, 2009·Anaesthesia·T Fuchs-BuderC Meistelman

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Citations

Aug 28, 2012·International Journal of Obstetric Anesthesia·N SadanaM K Farber
Sep 25, 2017·Acta neurologica Belgica·Andrew R MortensonToby N Weingarten
Nov 21, 2019·BMC Anesthesiology·Usha GurunathanLisa May Lin Stanton

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