Abstract | PURPOSE: CLINICAL FEATURES: A 63-yr-old-male with an American Society of Anesthesiologists Physical Status score of III underwent a left hip arthroplasty under general anesthesia for osteoarthritis. Preoperative pulmonary function testing indicated a restrictive impairment. Anesthesia was induced with fentanyl, remifentanil, propofol, and 0.73 mg·kg-1 of rocuronium. The train-of-four (TOF) count was 0 for the 273-min duration of surgery. After repeated doses of sugammadex failed to recover the TOF count and spontaneous respirations, a total of 1,200 mg (17.3 mg·kg-1) of sugammadex, which was assumed to be a sufficient amount for capturing the residual rocuronium, was administered. Although the patient expressed that he was awake via eye blinking, he could not breathe. Thus, he was placed on mechanical ventilation for 18 hr after surgery. A postoperative neurology consultation revealed a delayed nerve conduction velocity of 20 m·sec-1 and a mutated duplication of the PMP22 gene; a diagnosis of CMT1A was made. CONCLUSIONS: Our case shows that rocuronium can cause a prolonged neuromuscular respiratory paralysis refractory to sugammadex in patients with CMT1A and impaired respiratory function. Our case may also indicate that restrictive pulmonary impairment and low nerve conduction velocity of 20 m·sec-1 are predictive factors that cause prolonged neuromuscular respiratory paralysis refractory to sugammadex in CMT1A.
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Authors | Sakiko Hiramatsu, Katsuyuki Moriwaki, Miwako Nakao, Yasuo M Tsutsumi |
Journal | Canadian journal of anaesthesia = Journal canadien d'anesthesie
(Can J Anaesth)
Vol. 69
Issue 3
Pg. 364-368
(03 2022)
ISSN: 1496-8975 [Electronic] United States |
Vernacular Title | Un cas de paralysie respiratoire induite par rocuronium réfractaire au sugammadex dans la maladie de Charcot-Marie-Tooth. |
PMID | 34902106
(Publication Type: Journal Article)
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Copyright | © 2021. The Author(s). |
Chemical References |
- Androstanols
- Neuromuscular Nondepolarizing Agents
- Sugammadex
- Rocuronium
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Topics |
- Androstanols
(adverse effects)
- Anesthesia Recovery Period
- Anesthesia, General
- Charcot-Marie-Tooth Disease
(chemically induced, complications)
- Humans
- Male
- Neuromuscular Blockade
(adverse effects)
- Neuromuscular Nondepolarizing Agents
- Respiratory Paralysis
(chemically induced)
- Rocuronium
- Sugammadex
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