title: A temporary decrease in twitch response following reversal of rocuronium-induced neuromuscular block with a small dose of sugammadex in a pediatric patient.
abstract: We report a temporary decrease in twitch response following reversal of rocuronium-induced neuromuscular block with a small dose of sugammadex in our dose-finding study in pediatric patients. A 19-month-old female infant (9.6 kg, 80 cm) was scheduled for elective cheiloplasty surgery. Anesthesia was induced with nitrous oxide 50% and sevoflurane 5% and maintained with air, oxygen, sevoflurane 3%, and fentanyl (total, 3 μg/kg). Neuromuscular monitoring was performed at the adductor pollicis muscle after induction of anesthesia but before the administration of rocuronium. Total dose of rocuronium during the surgery was 0.9 mg/kg. Neuromuscular block was reversed with 0.5 mg/kg sugammadex when one response was observed with post-tetanic count stimulation. Twitch responses after sugammadex administration showed a temporary decrease after its initial recovery. Maximum decreases in twitch responses were observed 17 min after initial dose of sugammadex. Twitch responses recovered to their control values after additional doses of 3.5 mg/kg sugammadex (4 mg/kg in total). Time from sugammadex administration to maximum decreases in twitch responses is earlier than has been reported in adults (20-70 min). It is demonstrated that following neuromuscular block reversal with insufficient dose of sugammadex, there is a possibility of the recurrence of residual paralysis within less than 20 min in pediatric patients.
authors: Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, 2-1-1-1 Midorigaoka-higashi, Asahikawa, Hokkaido, 078-8510, Japan, iwasakih@asahikawa-med.ac.jp.
authors: Hajime
authors: H
authors: Iwasaki
authors: Kenichi
authors: K
authors: Takahoko
authors: Shigeaki
authors: S
authors: Otomo
authors: Tomoki
authors: T
authors: Sasakawa
authors: Takayuki
authors: T
authors: Kunisawa
authors: Hiroshi
authors: H
authors: Iwasaki
mesh_terms: D000732:Androstanols / Q000627:therapeutic use*; D000762:Anesthesia Recovery Period; D018685:Anesthetics, Inhalation / Q000627:therapeutic use; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007223:Infant; D008738:Methyl Ethers / Q000627:therapeutic use; D019148:Neuromuscular Blockade / Q000379:methods*; D061886:Neuromuscular Monitoring; D003473:Neuromuscular Nondepolarizing Agents / Q000627:therapeutic use*; D009609:Nitrous Oxide / Q000627:therapeutic use; D000077123:Rocuronium; D000077149:Sevoflurane; D000077122:Sugammadex; D047408:gamma-Cyclodextrins / Q000627:therapeutic use*
chemical_list: D000732:Androstanols; D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D003473:Neuromuscular Nondepolarizing Agents; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D000077149:Sevoflurane; D009609:Nitrous Oxide; D000077123:Rocuronium
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