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

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    Authors
    Weekes, G
    Hayes, N
    Bowen, M
    Affiliation
    Department of Anaesthesiology, Rotunda Hospital, Dublin, Ireland., gavin.weekes@gmail.com
    Issue Date
    2012-02-01T10:38:12Z
    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
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    Citation
    Int J Obstet Anesth. 2010 Jul;19(3):333-6. Epub 2010 Jun 2.
    Journal
    International journal of obstetric anesthesia
    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
    ISSN
    1532-3374 (Electronic)
    0959-289X (Linking)
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.ijoa.2010.03.009
    Scopus Count
    Collections
    Rotunda Hospital

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