The use of sugammadex in a patient with myasthenia gravis.
Myasthenia gravis, affecting neuromuscular transmission, leads to a large variability in sensitivity to depolarising and non-depolarising neuromuscular blocking drugs. We report the successful use of the modified mu-cyclodextrin sugammadex in a myasthenic patient to reverse a rocuronium-induced deep level of neuromuscular block. After spontaneous neuromuscular recovery of T2 (second twitch of the train-of-four series), we administered 2 mg.kg(-1) of sugammadex intravenously, reversing neuromuscular blockade to a train-of-four ratio (T4/T1) > 90% within 210 s. Sugammadex, in combination with objective neuromuscular monitoring, can be used to reverse rocuronium-induced neuromuscular blockade in patients with myasthenia gravis, thereby avoiding the need for reversal with acetylcholinesterase inhibitors.
Unterbuchner
C
C
Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, München, Germany. c.unterbuchner@lrz.tum.de
Fink
H
H
Blobner
M
M
D000368:Aged; D000732:Androstanols / Q000037:antagonists & inhibitors*; D000762:Anesthesia Recovery Period; D006801:Humans; D008297:Male; D009157:Myasthenia Gravis / Q000503:physiopathology*; D019148:Neuromuscular Blockade / Q000379:methods; D009469:Neuromuscular Junction / Q000187:drug effects; D003473:Neuromuscular Nondepolarizing Agents / Q000037:antagonists & inhibitors*; D011182:Postoperative Care / Q000379:methods; D000077123:Rocuronium; D000077122:Sugammadex; D047408:gamma-Cyclodextrins / Q000494:pharmacology*
D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D000077123:Rocuronium