A new approach to anesthesia management in myasthenia gravis: reversal of neuromuscular blockade by sugammadex.
A neuromuscular blocking drug (NMBD) induced neuromuscular blockade (NMB) in patients with myasthenia gravis usually dissipates either spontaneously or by administration of neostigmine. We administered sugammadex to a patient with myasthenia gravis to reverse a rocuronium-induced profound NMB. NMBDs predispose such patients to severe postoperative residual paralysis and respiratory complications. Sugammadex binds steroidal NMBDs and, therefore reverses a rocuronium or vecuronium-induced NMB, without interfering with cholinergic transmission. A rapid and complete recovery from profound NMB was achieved and no adverse events were observed. This case suggests that sugammadex is a safe and effective antagonist of a rocuronium induced NMB blockade in patients with myasthenia gravis.
de Boer
H D
HD
Department of Anesthesiology and Pain Medicine, Martini General Hospital Groningen, the Netherlands. HD.de.Boer@mzh.nl
van Egmond
J
J
Driessen
J J
JJ
Booij
L H J D
LH
D000368:Aged; D000732:Androstanols / Q000009:adverse effects / Q000037:antagonists & inhibitors*; D000762:Anesthesia Recovery Period; D001943:Breast Neoplasms / Q000150:complications / Q000601:surgery; D004198:Disease Susceptibility; D005260:Female; D006801:Humans; D008408:Mastectomy; D009157:Myasthenia Gravis / Q000150:complications / Q000503:physiopathology*; D019148:Neuromuscular Blockade / Q000009:adverse effects*; D003473:Neuromuscular Nondepolarizing Agents / Q000009:adverse effects / Q000037:antagonists & inhibitors*; D010243:Paralysis / Q000139:chemically induced / Q000188:drug therapy; D011183:Postoperative Complications / Q000139:chemically induced / Q000188:drug therapy; D011229:Preanesthetic Medication; D000077123:Rocuronium; D021701:Sentinel Lymph Node Biopsy; D000077122:Sugammadex; D047408:gamma-Cyclodextrins / Q000008:administration & dosage / Q000627:therapeutic use*
D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D000077123:Rocuronium