A new approach to anesthesia management in myasthenia gravis: reversal of neuromuscular blockade by sugammadex.

Abstract

A neuromuscular blocking drug (NMBD) induced neuromuscular blockade (NMB) in patients with myasthenia gravis usually dissipates either spontaneously or by administration of neostigmine. We administered sugammadex to a patient with myasthenia gravis to reverse a rocuronium-induced profound NMB. NMBDs predispose such patients to severe postoperative residual paralysis and respiratory complications. Sugammadex binds steroidal NMBDs and, therefore reverses a rocuronium or vecuronium-induced NMB, without interfering with cholinergic transmission. A rapid and complete recovery from profound NMB was achieved and no adverse events were observed. This case suggests that sugammadex is a safe and effective antagonist of a rocuronium induced NMB blockade in patients with myasthenia gravis.

• Authors: H D de Boer, J van Egmond, J J Driessen, L H J D Booij
• Journal: Revista espanola de anestesiologia y reanimacion (Rev Esp Anestesiol Reanim) Vol. 57 Issue 3 Pg. 181-4 (Mar 2010) ISSN: 0034-9356 [Print] Spain
• PMID: 20422852 (Publication Type: Case Reports, Journal Article)

Chemical References

• Androstanols
• Neuromuscular Nondepolarizing Agents
• gamma-Cyclodextrins
• Sugammadex
• Rocuronium

Topics

• Aged
• Androstanols (adverse effects, antagonists & inhibitors)
• Anesthesia Recovery Period
• Breast Neoplasms (complications, surgery)
• Disease Susceptibility
• Female
• Humans
• Mastectomy
• Myasthenia Gravis (complications, physiopathology)
• Neuromuscular Blockade (adverse effects)
• Neuromuscular Nondepolarizing Agents (adverse effects, antagonists & inhibitors)
• Paralysis (chemically induced, drug therapy)
• Postoperative Complications (chemically induced, drug therapy)
• Preanesthetic Medication
• Rocuronium
• Sentinel Lymph Node Biopsy
• Sugammadex
• gamma-Cyclodextrins (administration & dosage, therapeutic use)