rocuronium and Amyotrophic-Lateral-Sclerosis

Patients with motor neuron diseases, such as amyotrophic lateral sclerosis (ALS), have higher sensitivity to nondepolarizing neuromuscular blocking agents (NMBAs) and are at higher risk for a residual block. For this reason, the use of NMBAs such as rocuronium has been limited owing to the delayed reversal of muscle relaxation. It was recently reported that rapid and effective reversal of muscle relaxation occurs when sugammadex, a muscle relaxant reversal drug, is administered to patients in ALS with rocuronium-induced muscle relaxation. However, in this paper, we report the incomplete recovery and recurarization of muscle relaxation after sugammadex administration in ALS patients, and delayed recovery of muscle relaxation after additional administration of sugammadex.. A 71-year-old male patient with ALS received general anesthesia for laparoscopic nephroureterectomy.. The patient was diagnosed with ALS 2 years earlier, and scheduled to undergo laparoscopic nephroureterectomy for ureteral cancer.. We used sugammadex for the reversal of deep neuromuscular block. We measured a train-of-four (TOF) count of 4 and a TOF ratio of 54% at about 8 min after administration of 4 mg/kg sugammadex. However, then the TOF count decreased to 1 to 3 and tidal volume (TV) decreased to < 100 mL. Therefore, an additional 50 mg sugammadex was administered intravenously 12 min after the first dose of sugammadex was injected.. The patient's vital signs were stable and his recovery from anesthesia was uneventful. Therefore, he was discharged to the intensive care unit. The patient had aspiration pneumonia symptoms owing to dysphagia on the third postoperative day, but after the symptoms improved he was transferred to the hospital for rehabilitation of dysphagia and dyspnea.. It is critical to monitor whether muscle relaxation is sufficiently reversed when using sugammadex in ALS patients. Further research is needed to determine the appropriate dose of sugammadex for muscle relaxation reversal.

Topics: Aged; Amyotrophic Lateral Sclerosis; Humans; Laparoscopy; Male; Neuromuscular Nondepolarizing Agents; Rocuronium; Sugammadex; Ureteral Diseases

We herein present 2 cases involving the combination of rocuronium and sugammadex in patients with motor neuron disease. The patients were a 54-year-old man with progressive muscular atrophy who underwent removal of internal fixators in the arm and leg, and a 66-year-old woman with amyotrophic lateral sclerosis who underwent skin grafting in the left lower leg. General anesthesia was induced with propofol, rocuronium, and remifentanil and maintained with desflurane and remifentanil. At the end of the surgical procedure, we administered sugammadex. Three or 4 minutes after administration of sugammadex, the patients began to breathe spontaneously and were extubated without complications.. Sugammadex can be used successfully to reverse neuromuscular blockade in patients with motor neuron disease.

Topics: Aged; Amyotrophic Lateral Sclerosis; Androstanols; Anesthesia Recovery Period; Female; gamma-Cyclodextrins; Humans; Male; Middle Aged; Muscular Atrophy, Spinal; Neuromuscular Agents; Neuromuscular Blockade; Rocuronium; Sugammadex

A 47-year-old woman with amyotrophic lateral sclerosis was scheduled for total thyroidectomy with cervical node dissection. During anesthetic management by total intravenous anesthesia using remifentanil, propofol, and rocuronium, train-of-four (TOF) monitoring findings were not consistent with clinical signs. Sugammadex successfully reversed shallow respiration.

Topics: Amyotrophic Lateral Sclerosis; Androstanols; Anesthesia, Intravenous; Anesthetics, Intravenous; Female; gamma-Cyclodextrins; Humans; Intraoperative Complications; Lymph Node Excision; Middle Aged; Neuromuscular Nondepolarizing Agents; Piperidines; Propofol; Remifentanil; Respiratory Insufficiency; Rocuronium; Sugammadex; Thyroidectomy

To report on general anesthesia management in amyotrophic lateral sclerosis.. A 47-year-old man presented with fracture of the humerus. The patient was diagnosed with amyotrophic lateral sclerosis. General anesthesia was induced with propofol, rocuronium and remifentanil. After uneventful surgical repair, TOF (train-of-four) ratio reached >0.90 at the end of operation. However, muscle strength and tidal volume were inadequate. After sugammadex 2 mg kg(-1) i.v. was given, the patient was extubated 120 s later.. This case highlights that rocuronium and sugammadex can be used safely in patients with amyotrophic lateral sclerosis undergoing surgery with general anesthesia.

Topics: Amyotrophic Lateral Sclerosis; Androstanols; Anesthesia Recovery Period; Anesthesia, General; Fractures, Bone; gamma-Cyclodextrins; Humans; Humerus; Male; Middle Aged; Neuromuscular Nondepolarizing Agents; Orthopedic Procedures; Patient Safety; Rocuronium; Sugammadex

We experienced an anesthetic management with rocuronium and neurostimulator for a surgical patient with amyotrophic lateral sclerosis. A 61-year-old man was scheduled for intrathecal baclofen pump implantation as treatment for his spasticity under general anesthesia. After oxygenation and totally intravenous induction with propofol and remifentanil, we administered 10 mg of rocuronium repeatedly monitoring with neurostimulator. When dosage of rocuronium reached 20 mg, train-of-four count reached 1 and his trachea was intubated without coughing or moving. Anesthesia was maintained intravenously. Train-of-four ratio recovered to 95%, 22 minutes after the first administration of rocuronium. Operation was accomplished uneventfully with no additional rocuronium. Bispectral index value recovered to 98 and the patient awoke and breathed spontaneously 19 minutes after termination of administration of anesthetic agents. We could confirm his stable and adequate respiration and trachea was extubated without reversal of rocuronium. In the postanesthesia care unit, he showed no discomfort and was returned to the ward. His symptoms did not deteriorate postoperatively and he was discharged on the 36th postoperative day.

Topics: Amyotrophic Lateral Sclerosis; Androstanols; Anesthesia, General; Baclofen; Humans; Infusion Pumps, Implantable; Injections, Spinal; Male; Middle Aged; Monitoring, Physiologic; Muscle Relaxants, Central; Neuromuscular Nondepolarizing Agents; Rocuronium

A 31-year-old woman with amyotrophic lateral sclerosis (ALS) with respiratory muscle paralysis was scheduled for tracheotomy. After applying standard neuromuscular monitoring devices, general anesthesia was induced and maintained with propofol, remifentanil, rocuronium, and sevoflurane. Sugammadex is a potent agent for reversal of neuromuscular blockade by rocuronium. The patient emerged from general anesthesia smoothly using sugammadex; however, assisted respiration was continued for possible prolongation of the effect of muscle relaxant. The postoperative course was uneventful, and she was discharged without any discomfort.

Topics: Adult; Amyotrophic Lateral Sclerosis; Androstanols; Anesthesia, General; Female; gamma-Cyclodextrins; Humans; Neuromuscular Nondepolarizing Agents; Respiratory Paralysis; Rocuronium; Sugammadex; Tracheotomy

Amyotrophic lateral sclerosis (ALS) is a degenerative disease involving motor neurons. The anesthetic problem is increased susceptibility to non-depolarizing muscle relaxants and the feasibility of spinal and epidural anesthesia. An 86-year-old man with ALS underwent colostomy to the ileus. We chose general anesthesia with propofol, remifentanil, rocuronium and sugammadex. We administered 30 mg (0.52 mg . kg-1) of rocuronium only for induction. TOF-count was 2 at the end of operation. At spontaneous neuromuscular recovery to TOF-count 3, we administered sugammadex 2.1 mg . kg-1. The patient emerged from general anesthesia smoothly, and was extubated. Post-operative course was uneventful. Our anesthetic management of ALS patient using sugammadex was successful. Further evidence is required to establish appropriate use of sugammadex for ALS patients.

Topics: Aged, 80 and over; Amyotrophic Lateral Sclerosis; Androstanols; Anesthesia Recovery Period; Anesthesia, General; Colostomy; gamma-Cyclodextrins; Humans; Ileus; Intraoperative Care; Male; Neuromuscular Depolarizing Agents; Rocuronium; Sugammadex