Recurarization Following Adequate Dose of Sugammadex Reversal in a Patient Monitored with Aceleromyography

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  • IGA Shinji
    Department of Anesthesiology and Resuscitology, Okayama University Hospital
  • SHIMIZU Kazuyoshi
    Department of Anesthesiology and Resuscitology, Okayama University Hospital
  • KAWADE Kenji
    Department of Anesthesiology and Resuscitology, Okayama University Hospital
  • KANAZAWA Tomoyuki
    Department of Anesthesiology and Resuscitology, Okayama University Hospital
  • NISHITANI Kyoko
    Department of Anesthesiology and Resuscitology, Okayama University Hospital
  • MORIMATSU Hiroshi
    Department of Anesthesiology and Resuscitology, Okayama University Hospital

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  • スガマデクス投与後ロクロニウムの再クラーレ化が疑われた1症例

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There are a few reports regarding recurarization, which is mainly caused by insufficient dosage of sugammadex. However, there is no report of recurarization after adequate usage of sugammadex according to recommendation. We experienced a patient in whom recurarization occurred despite using sugammadex under proper monitoring with aceleromyography during the operation. A 78-year-old man with a slight renal impairment was scheduled for laparoscopic distal gastrectomy under general anesthesia with sevoflurane, fentanyl and remifentanil. Muscle relaxation was induced and maintained with rocuronium with continuous monitoring using TOF Watch SX®. At the end of the procedure, two twitches were visualized after supramaximal train-of-four stimulation at the adductor pollicis muscle. His tracheal tube was removed after administration of sugammadex 200 mg (3.6 mg/kg). Seventy minutes later, he complained of difficulty breathing and an immobilization of his limbs with desaturation. After the additional dose of sugammadex 200 mg (3.6 mg/kg), oxygenation and mobilization were dramatically improved. There is a risk of recurarization even when the recommended dose of sugammadex is administered, so it is necessary to observe a patient closely for a while even after extubation.

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