title: [Sugammadex reversal after extubation under muscle relaxation to prevent cough reflex in a patient with intractable spontaneous pneumothorax].
abstract: A 40-year-old man (168 cm tall and weighing 71 kg) with intractable pneumothorax was operated for resection of a bulla in the left lung. After insertion of epidural catheter via T 5-6 interspace, general anesthesia was induced and maintained with propofol, remifentanil and rocuronium. The duration of surgery was 1h 48 min and rocuronium given during surgery was 110 mg. After completion of surgery, the double-lumen tube was replaced with laryngeal mask airway to prevent cough reflex. However, infusion of sugammadex 200 mg induced mild cough reflex, resulting in air leakage from thoracic drainage. Because air leakage still continued after extubation, reoperation must be done and re-intubation was required. Since rocuronium 50 mg did not provide satisfactory muscle relaxation measured by train of four, additional dose of rocuronium 40 mg was administered and re-intubation was successfully performed without cough reflex. Reoperation lasted for 43 minutes and rocuronium infused was 100 mg. Nasal airway was inserted to prevent airway obstruction by the tongue and extubation was performed under muscle relaxation with infusion of rocuronium 10 mg. And then, immediate administration of sugammadex 400 mg could elicit spontaneous respiration without cough reflex.
authors.affiliation: Department of Anesthesiology and Intensive Care, Osaka University Graduate School of Medicine, Suita 565-0871.
authors.forename: Chiho
authors.initials: C
authors.lastname: Ota
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Ueta
authors.forename: Tatsuyuki
authors.initials: T
authors.lastname: Imada
authors.forename: Yukio
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Takashi
authors.initials: T
authors.lastname: Mashimo
mesh_terms: D000328:Adult; D060666:Airway Extubation / Q000379:methods; D000732:Androstanols / Q000494:pharmacology; D000768:Anesthesia, General; D003371:Cough / Q000517:prevention & control*; D006801:Humans; D008297:Male; D003473:Neuromuscular Nondepolarizing Agents / Q000494:pharmacology; D011030:Pneumothorax / Q000601:surgery*; D012018:Reflex; D000077123:Rocuronium; D000077122:Sugammadex; D047408:gamma-Cyclodextrins / Q000627:therapeutic use*
chemical_list: D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D000077123:Rocuronium