Maternal respiratory distress and successful reversal with sugammadex during intrauterine transfusion with fetal paralysis. (August 2019)

• Record Type: Journal Article
• Authors: Munro, A.; McKeen, D.; Coolen, J.
• Is Part Of: International journal of obstetric anesthesia. Volume 39(2019)
• Page Start: 129
• Page End: 131
• Publication Date: 2019-08
• Subjects: Intrauterine transfusion -- Neuromuscular blockade; Obstetrics -- Periodicals; Anesthesia -- Periodicals; Anesthésie en obstétrique -- Périodiques; Anesthesia; Obstetrics; Electronic journals; Periodicals; 617.9682
• DOI: 10.1016/j.ijoa.2019.01.002
• Languages: English
• ISSNs: 0959-289X

Abstract

Highlights: Fetal paralysis improves ease and safety for intrauterine transfusion (IUT). Inadvertent maternal neuromuscular blockade may occur during IUT. Sugammadex provided complete reversal of maternal paralysis with rocuronium. During IUT, reversal agents should be available for maternal respiratory distress. Management protocols are required when fetal paralysis is used in ambulatory care. Abstract: A 70 kg, 34-year-old woman at 29 weeks-of-gestation required intrauterine transfusion for Rh (D) alloimmunization. In the ambulatory treatment clinic, 19 mg of rocuronium was administered intramuscularly in split doses into the fetal buttock. The fetus moved and inadvertent maternal neuromuscular blockade occurred, leading to respiratory distress. The patient was transferred to the operating room where she had poor muscle tone, dyspnea and dysphonia. Sugammadex 100 mg was administered intravenously and complete resolution of neuromuscular blockade was demonstrated using a Neuromuscular Transmission™ monitor. When neuromuscular blocking agents are administered in ambulatory settings, management protocols, reversal agents, and skilled assistance should be immediately available for managing potentially life-threatening complications.