Use of rocuronium and sugammadex for caesarean delivery in a patient with myasthenia gravis

Department of Anaesthesia and Critical Care, Hôpital de Hautepierre, University of Strasbourg Strasbourg, France.
International journal of obstetric anesthesia (Impact Factor: 1.6). 05/2012; 21(3):286-7. DOI: 10.1016/j.ijoa.2012.02.006
Source: PubMed
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    • "Case reports in patients with myasthenia gravis document the successful use of sugammadex (six case reports). For other rare muscular diseases like Duchenne muscular dystrophy recent reports document the successful reversal of rocuronium with sugammadex in pediatric patients [5–9]. "
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    ABSTRACT: Duchenne's muscular dystrophy (DMD) is the most common and severe form of myopathy. Patients with DMD are more sensitive to sedative, anesthetic, and neuromuscular blocking agents which may result in intraoperative and early postoperative cardiovascular and respiratory complications, as well as prolonged recovery from anesthesia. In this case report, we describe a 25-year-old male patient admitted for cholecystectomy under general anesthesia. We induced our anesthesia by oxygen, propofol, fentanyl, and rocuronium bromide. Maintenance was done by fentanyl, rocuronium bromide, sevoflurane, and O2. We report in this case the safety use of sugammadex to antagonize the neuromuscular block and rapid recovery in such category of patients.
    03/2014; 2014(6):680568. DOI:10.1155/2014/680568
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    • "The new strategy of muscle relaxant reversal using sugammadex seems to be a safe and reliable option in these patients. Six case reports in patients with myasthenia gravis document the successful use of sugammadex.76–80 For other rare muscular diseases, such as dermatomyositis,81 Duchenne muscular dystrophy,82 myotonic dystrophy,83–88 spinal muscular atrophy,88,89 and amyotrophic lateral sclerosis,90 case reports document the successful reversal of rocuronium with sugammadex, so that muscle function was quickly and reliably restored to the patients’ preoperative state. "
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    ABSTRACT: Sugammadex is the first clinical representative of a new class of drugs called selective relaxant binding agents. It has revolutionized the way anesthesiologists think about drug reversal. Sugammadex selectively binds rocuronium or vecuronium, thereby reversing their neuromuscular blocking action. Due to its 1:1 binding of rocuronium or vecuronium, it is able to reverse any depth of neuromuscular block. So far, it has been approved for use in adult patients and for pediatric patients over 2 years. Since its approval in Europe, Japan, and Australia, further insight on its use in special patient populations and specific diseases have become available. Due to its pharmacodynamic profile, sugammadex, in combination with rocuronium, may have the potential to displace succinylcholine as the "gold standard" muscle relaxant for rapid sequence induction. The use of rocuronium or vecuronium, with the potential of reverse of their action with sugammadex, seems to be safe in patients with impaired neuromuscular transmission, ie, neuromuscular diseases, including myasthenia gravis. Data from long-term use of sugammadex is not yet available. Evidence suggesting an economic advantage of using sugammadex and justifying its relatively high cost for an anesthesia-related drug, is missing.
    Core Evidence 09/2013; 8:57-67. DOI:10.2147/CE.S35675
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    ABSTRACT: Background: The use of neuromuscular blocking agents is still controversial in myasthenic patients but rocuronium could be useful after the introduction of sugammadex as a selective antagonist. The aim of the study was to evaluate the use of rocuronium-sugammadex in myasthenic patients undergoing thoracoscopic thymectomy. Methods: After ethical approval, 10 myasthenic patients undergoing videothoracoscopic-assisted thymectomy were enrolled in the study. Neuromuscular block was achieved with 0.3 mg/kg rocuronium and additional doses were given according to train-of-four (TOF) monitoring or movement of the diaphragm. Sugammadex 2 mg/kg was given after surgery. Recovery time (time to obtain a TOF value > 0.9) was recorded for all subjects. Result: All patients were extubated in the operating room after administration of sugammadex. Mean rocuronium dose was 48 mg and the average operation time was 62 min. Recovery time after sugammadex administration was 111 s (min 35; max 240). Conclusions: A rapid recovery of neuromuscular function was found in myasthenic patients receiving rocuronium when sugammadex was used for reversal. This combination could be a rational alternative for myasthenic patients for whom neuromuscular blockade is mandatory during surgery.
    Acta Anaesthesiologica Scandinavica 05/2013; 57(6). DOI:10.1111/aas.12123 · 2.32 Impact Factor
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