Unanticipated Profound Paralysis and Sugammadex Dosing Implications After Videoscopic Thoracic Surgery. (March 2022)

• Record Type: Journal Article
• Authors: McKittrick, Melissa L.; Lombard, Frederick W.
• Is Part Of: Seminars in cardiothoracic and vascular anesthesia. Volume 26:Number 1(2022)
• Page Start: 86
• Page End: 89
• Publication Date: 2022-03
• Subjects: critical care -- intensive care unit -- intraoperative assessment -- minimally invasive surgery -- monitoring -- thoracic surgery; Cardiovascular system -- Surgery -- Methods -- Periodicals; Chest -- Surgery -- Methods -- Periodicals; Anesthesia -- Periodicals; Anesthetics -- Periodicals; Anesthesia -- Periodicals; Anesthetics -- Periodicals; Cardiovascular Surgical Procedures -- methods -- Periodicals; Thoracic Surgical Procedures -- methods -- Periodicals; 617.96
• DOI: 10.1177/10892532211059885
• Languages: English
• ISSNs: 1089-2532

Abstract

A bedridden patient with empyema presented for thoracoscopic decortication. During the procedure, despite a post-tetanic count (PTC) of 0 via calibrated quantitative neuromuscular monitoring, persistent diaphragmatic movement impaired operating conditions, so rocuronium was re-dosed. After surgery, the patient had 0 PTC. Sugammadex was titrated to achieve baseline neuromuscular strength, monitoring the effect of each 200-mg dose. Ultimately, 1200 mg was required to achieve baseline strength. We describe monitor troubleshooting, considerations with unexpectedly deep neuromuscular blockade, the importance of routine quantitative neuromuscular monitoring, and one strategy for sugammadex reversal in patients with profound paralysis outside of the standard dosing guidelines.