Failure of Reversion of Neuromuscular Block With Sugammadex in Patient With Myasthenia Gravis

Case Report and Brief Review of Literature

Hermann dos Santos Fernandes; Jorge Luiz Saraiva Ximenes; Daniel Ibanhes Nunes; Hazem Adel Ashmawi; Joaquim Edson Vieira


BMC Anesthesiol. 2019;19(160) 

In This Article

Abstract and Introduction


Background: Myasthenia gravis (MG) is a challenge for anesthesia management. This report shows that the use of rocuronium-sugammadex is not free from flaws and highlights the importance of cholinesterase inhibitors management and neuromuscular block monitoring in the perioperative period of myasthenic patients.

Case presentation: Myasthenic female patient submitted to general balanced anesthesia using 25 mg of rocuronium. Under train-of-four (TOF) monitoring, repeated doses of sugammadex was used in a total of 800 mg without recovery of neuromuscular blockade, but TOF ratio (TOFR) was stabilized at 60%. Neostigmine administration led to the improvement of TOFR.

Conclusions: Although the use of rocuronium-sugammadex seems safe, we should consider their unpredictability in myasthenic patients. This report supports the monitoring of neuromuscular blockade as mandatory in every patient, especially the myasthenic ones.