title: A case series of re-establishment of neuromuscular block with rocuronium after sugammadex reversal.
abstract: We report the use of rocuronium to re-establish neuromuscular block after reversal with sugammadex. The aim of this study was to investigate the relationship between the dose of rocuronium needed to re-establish neuromuscular block and the time interval between sugammadex administration and re-administration of rocuronium. Patients who required re-establishment of neuromuscular block within 12 h after the reversal of rocuronium-induced neuromuscular block with sugammadex were included. After inducing general anesthesia and placing the neuromuscular monitor, the protocol to re-establish neuromuscular block was as follows. An initial rocuronium dose of 0.6 mg/kg was followed by additional 0.3 mg/kg doses every 2 min until train-of-four responses were abolished. A total of 11 patients were enrolled in this study. Intervals between sugammadex and second rocuronium were 12-465 min. Total dose of rocuronium needed to re-establish neuromuscular block was 0.6-1.2 mg/kg. 0.6 mg/kg rocuronium re-established neuromuscular block in all patients who received initial sugammadex more than 3 h previously. However, when the interval between sugammadex and second rocuronium was less than 2 h, more than 0.6 mg/kg rocuronium was necessary to re-establish neuromuscular block.
authors.affiliation: 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.forename: Hajime
authors.initials: H
authors.lastname: Iwasaki
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, 2-1-1-1 Midorigaoka-higashi, Asahikawa, Hokkaido, 078-8510, Japan.
authors.forename: Tomoki
authors.initials: T
authors.lastname: Sasakawa
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, 2-1-1-1 Midorigaoka-higashi, Asahikawa, Hokkaido, 078-8510, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Takahoko
authors.affiliation: Department of Anesthesiology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Shunichi
authors.initials: S
authors.lastname: Takagi
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Kawasaki Medical School, Okayama, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Nakatsuka
authors.affiliation: Department of Anesthesiology, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Suzuki
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, 2-1-1-1 Midorigaoka-higashi, Asahikawa, Hokkaido, 078-8510, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Iwasaki
mesh_terms: D000328:Adult; D000368:Aged; D000732:Androstanols / Q000008:administration & dosage*; D000768:Anesthesia, General / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019148:Neuromuscular Blockade / Q000379:methods*; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage; D000077123:Rocuronium; D000077122:Sugammadex; D047408:gamma-Cyclodextrins / Q000008:administration & dosage*
chemical_list: D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D000077123:Rocuronium
keywords: Repeat surgery; Rocuronium; Sugammadex