title: [Case of anesthesia for thoracoscopic thymectomy in a pediatric patient with myasthenia gravis: reversal of rocuronium-induced neuromuscular blockade with sugammadex].
abstract: Neuromuscular blocking drugs (NMBDs) can predispose patients with myasthenia gravis to postoperative paralysis and respiratory complications. We had a 12-year-old female patient undergoing thoracoscopic thymectomy. She had suffered from MGFA class IIa (mild systemic) myasthenia gravis for 4 months. Anesthesia was induced with 3 mg x kg(-1) of thiopental and 0.2 mg x kg(-1) of rocuronium, which was given incrementally to achieve 100% blockade. Anesthesia was maintained with oxygen, air, 2% sevoflurane and 0.2 microg x kg(-1) x min(-1) of remifentanil. 0.05 mg x kg(-1) of rocuronium was added when the TOF ratio recovered to 20%. Towards the end of the surgery, remifentanil was withdrawn and 4 microg x kg(-1) of fentanyl was given. Intercostal nerve block with 0.2% ropivacaine was performed to relieve postoperative pain. TOF ratio was 32% at the end, when we gave 2 mg x kg(-1) of sugammadex to get 100% reversal of neuromuscular blockade in 120 seconds. There was no residual paralysis and respiratory complications postoperatively.
authors.affiliation: Department of Anesthesiology, Tokyo Medical University, Tokyo 160-8402.
authors.forename: Akiko
authors.initials: A
authors.lastname: Takeda
authors.forename: Makoto
authors.initials: M
authors.lastname: Kawamura
authors.forename: Izumi
authors.initials: I
authors.lastname: Hamaya
authors.forename: Hanae
authors.initials: H
authors.lastname: Kitamura
authors.forename: Rika
authors.initials: R
authors.lastname: Muto
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Mitono
mesh_terms: D000732:Androstanols / Q000008:administration & dosage* / Q000037:antagonists & inhibitors*; D000768:Anesthesia, General; D002648:Child; D005260:Female; D006801:Humans; D009157:Myasthenia Gravis / Q000601:surgery*; D019148:Neuromuscular Blockade; D003473:Neuromuscular Nondepolarizing Agents / Q000037:antagonists & inhibitors*; D019990:Perioperative Care; D000077123:Rocuronium; D012720:Severity of Illness Index; D000077122:Sugammadex; D013906:Thoracoscopy; D013934:Thymectomy; D047408:gamma-Cyclodextrins / Q000008:administration & dosage* / Q000494:pharmacology*
chemical_list: D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D000077123:Rocuronium