Reversal of prolonged rocuronium neuromuscular blockade with sugammadex in an obstetric patient with transverse myelitis.

Hdl Handle:
http://hdl.handle.net/10147/207728
Title:
Reversal of prolonged rocuronium neuromuscular blockade with sugammadex in an obstetric patient with transverse myelitis.
Authors:
Weekes, G; Hayes, N; Bowen, M
Affiliation:
Department of Anaesthesiology, Rotunda Hospital, Dublin, Ireland., gavin.weekes@gmail.com
Citation:
Int J Obstet Anesth. 2010 Jul;19(3):333-6. Epub 2010 Jun 2.
Journal:
International journal of obstetric anesthesia
Issue Date:
1-Feb-2012
URI:
http://hdl.handle.net/10147/207728
DOI:
10.1016/j.ijoa.2010.03.009
PubMed ID:
20627694
Abstract:
A 38-year-old wheelchair-bound primigravida with transverse myelitis presented at 38 weeks of gestation for elective caesarean section. Transverse myelitis, which is characterised by bilateral inflammation of the spinal cord and myelin destruction, is associated with myopathy, autonomic dysreflexia and pulmonary aspiration. Regional anaesthesia was contraindicated in this case as the patient had undergone two previous lumbar spinal fusion procedures. Rocuronium 1.2 mg/kg was used to facilitate rapid intubating conditions. The caesarean section proceeded uneventfully, but even after administration of neostigmine the patient exhibited prolonged neuromuscular blockade. After 3 h and 15 min sugammadex was obtained to reverse neuromuscular blockade; the drug was not stocked in our hospital. Sugammadex 4 mg/kg resulted in complete reversal of blockade after 2 min. We believe that myopathy associated with transverse myelitis led to the prolonged duration of action of rocuronium. Sugammadex is a relatively new drug with few reported side effects. In this case it was used to reverse neuromuscular blockade and prevented prolonged postoperative ventilatory support.
Language:
eng
MeSH:
Adult; Androstanols/adverse effects/*antagonists & inhibitors; Anesthesia, General; Anesthesia, Obstetrical; Cesarean Section; Female; Humans; Infant, Newborn; Male; Myelitis, Transverse/*complications; Neuromuscular Blockade/*adverse effects; Neuromuscular Nondepolarizing Agents/adverse effects/*antagonists & inhibitors; Paralysis/complications; Pregnancy; Pregnancy Complications/*therapy; gamma-Cyclodextrins/*therapeutic use
ISSN:
1532-3374 (Electronic); 0959-289X (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorWeekes, Gen_GB
dc.contributor.authorHayes, Nen_GB
dc.contributor.authorBowen, Men_GB
dc.date.accessioned2012-02-01T10:38:12Z-
dc.date.available2012-02-01T10:38:12Z-
dc.date.issued2012-02-01T10:38:12Z-
dc.identifier.citationInt J Obstet Anesth. 2010 Jul;19(3):333-6. Epub 2010 Jun 2.en_GB
dc.identifier.issn1532-3374 (Electronic)en_GB
dc.identifier.issn0959-289X (Linking)en_GB
dc.identifier.pmid20627694en_GB
dc.identifier.doi10.1016/j.ijoa.2010.03.009en_GB
dc.identifier.urihttp://hdl.handle.net/10147/207728-
dc.description.abstractA 38-year-old wheelchair-bound primigravida with transverse myelitis presented at 38 weeks of gestation for elective caesarean section. Transverse myelitis, which is characterised by bilateral inflammation of the spinal cord and myelin destruction, is associated with myopathy, autonomic dysreflexia and pulmonary aspiration. Regional anaesthesia was contraindicated in this case as the patient had undergone two previous lumbar spinal fusion procedures. Rocuronium 1.2 mg/kg was used to facilitate rapid intubating conditions. The caesarean section proceeded uneventfully, but even after administration of neostigmine the patient exhibited prolonged neuromuscular blockade. After 3 h and 15 min sugammadex was obtained to reverse neuromuscular blockade; the drug was not stocked in our hospital. Sugammadex 4 mg/kg resulted in complete reversal of blockade after 2 min. We believe that myopathy associated with transverse myelitis led to the prolonged duration of action of rocuronium. Sugammadex is a relatively new drug with few reported side effects. In this case it was used to reverse neuromuscular blockade and prevented prolonged postoperative ventilatory support.en_GB
dc.language.isoengen_GB
dc.subject.meshAdulten_GB
dc.subject.meshAndrostanols/adverse effects/*antagonists & inhibitorsen_GB
dc.subject.meshAnesthesia, Generalen_GB
dc.subject.meshAnesthesia, Obstetricalen_GB
dc.subject.meshCesarean Sectionen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHumansen_GB
dc.subject.meshInfant, Newbornen_GB
dc.subject.meshMaleen_GB
dc.subject.meshMyelitis, Transverse/*complicationsen_GB
dc.subject.meshNeuromuscular Blockade/*adverse effectsen_GB
dc.subject.meshNeuromuscular Nondepolarizing Agents/adverse effects/*antagonists & inhibitorsen_GB
dc.subject.meshParalysis/complicationsen_GB
dc.subject.meshPregnancyen_GB
dc.subject.meshPregnancy Complications/*therapyen_GB
dc.subject.meshgamma-Cyclodextrins/*therapeutic useen_GB
dc.titleReversal of prolonged rocuronium neuromuscular blockade with sugammadex in an obstetric patient with transverse myelitis.en_GB
dc.contributor.departmentDepartment of Anaesthesiology, Rotunda Hospital, Dublin, Ireland., gavin.weekes@gmail.comen_GB
dc.identifier.journalInternational journal of obstetric anesthesiaen_GB
dc.description.provinceLeinster-

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