title: The use of rocuronium in a patient with cystic fibrosis and end-stage lung disease made safe by sugammadex reversal.
abstract: While the pharmacology of sugammadex has been extensively reviewed, there is limited literature regarding its use in specific clinical settings. Several case reports describe its use in patients with the potential for postoperative respiratory dysfunction; in the settings of myasthenia gravis, Duchenne muscular dystrophy and myotonic dystrophy. We describe the use of sugammadex in a patient with severe bronchiectasis related to cystic fibrosis who required neuromuscular block for percutaneous endoscopic gastrostomy insertion. The use of rocuronium for neuromuscular block was preferred in order to avoid the potential complications associated with the use of suxamethonium. However we wished to ensure complete neuromuscular block reversal for this short duration procedure in this high-risk patient and also to avoid the side-effects of traditional reversal agents. We therefore planned in advance to use sugammadex for neuromuscular block reversal, and this approach proved successful. Overall, the combination of rocuronium and sugammadex improved perioperative surgical and anaesthetic management in this patient.
authors.affiliation: Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, New South Wales.
authors.forename: M V
authors.initials: MV
authors.lastname: Porter
authors.forename: M S
authors.initials: MS
authors.lastname: Paleologos
mesh_terms: D000328:Adult; D000732:Androstanols / Q000008:administration & dosage*; D001987:Bronchiectasis / Q000209:etiology / Q000473:pathology*; D003550:Cystic Fibrosis / Q000150:complications*; D005260:Female; D005773:Gastroscopy / Q000379:methods; D005774:Gastrostomy / Q000379:methods; D006801:Humans; D019148:Neuromuscular Blockade / Q000379:methods; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage; D000077123:Rocuronium; D012720:Severity of Illness Index; D000077122:Sugammadex; D016896:Treatment Outcome; D047408:gamma-Cyclodextrins / Q000008:administration & dosage*
chemical_list: D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D000077123:Rocuronium