title: [Insufficient sugammadex effect in an obese pregnant woman undergoing cesarean section under general anesthesia].
abstract: A 32-year-old pregnant woman (height 162 cm, weight 86 kg, age of fetus 25 weeks) without preoperative complications underwent an emergent cesarean section under general anesthesia. She was intubated with a 7.0-mm tracheal tube 40 s after receiving rocuronium 0.93 mg x kg(-1) and thiamilal 375 mg. Anesthesia was maintained with oxygen, air, sevoflurane 1.0-2.5%, and fentanyl 425 microg. Nine minutes after the end of surgery (operation time 71 minutes), a train-of-four count of 2 with 20 spontaneous breaths was noted, and sugammadex 2.3 mg x kg(-1) was administered. However, the train-of-four count was 3 even five minutes after sugammadex administration. Fifteen minutes after sugammadex administration (train-of-four ratio 14%), she received atropine 0.5 mg and neostigmine 1.0 mg. Ten minutes later, the train-of-four ratio increased to 89%, and the patient was successfully extubated with no respiratory suppression. We speculate that the rocuronium dose (0.93 mg x kg(-1)) was too high in this obese patient, and sugammadex dose at the end of the surgery was not enough for reversal of rocuronium-induced neuromuscular blockade.
authors.affiliation: Department of Anesthesia, Kyushu Kosei Nenkin Hospital, Kitakyushu 806-8501.
authors.forename: Kenji
authors.initials: K
authors.lastname: Kayashima
authors.affiliation: Nishinihon Occupational Health Service Center, Kitakyushu 803-0812.
authors.forename: Reiko
authors.initials: R
authors.lastname: Sozen
authors.affiliation: Department of Anesthesia, Kyushu Kosei Nenkin Hospital, Kitakyushu 806-8501.
authors.forename: Dan
authors.initials: D
authors.lastname: Okura
mesh_terms: D000328:Adult; D000732:Androstanols / Q000008:administration & dosage / Q000037:antagonists & inhibitors; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General; D000773:Anesthesia, Obstetrical; D002585:Cesarean Section; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D019148:Neuromuscular Blockade; D003473:Neuromuscular Nondepolarizing Agents / Q000037:antagonists & inhibitors; D009765:Obesity; D011182:Postoperative Care; D011247:Pregnancy; D011248:Pregnancy Complications; D000077123:Rocuronium; D000077122:Sugammadex; D013997:Time Factors; D047408:gamma-Cyclodextrins / Q000008:administration & dosage* / Q000494:pharmacology*
chemical_list: D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D000077123:Rocuronium