rocuronium and Muscular-Atrophy--Spinal

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

We report a successful management of anesthesia in a 55-year-old male patient with spinal and bulbar muscular atrophy (SBMA). His respiratory and swallowing functions were preserved preoperatively. He underwent an osteosynthesis for a femoral neck fracture under general anesthesia using nondepolarizing muscle relaxant. The anesthetic concerns in patients with SBMA are the possibility of postoperative respiratory dysfunction due to anesthetics or muscle relaxants and that of postoperative neurological deterioration due to spinal or epidural anesthesia. In this case, the effect of an intubating dose of rocuronium (0.5 mg · kg(-1)) was markedly prolonged, but it was completely reversed by sugammadex (2 mg · kg(-1)). Postoperative course was uneventful and clinical symptoms of SBMA did not become exacerbated.

Topics: Androstanols; Anesthesia, Epidural; Anesthesia, General; Drug Combinations; Femoral Neck Fractures; Fracture Fixation, Internal; gamma-Cyclodextrins; Humans; Male; Middle Aged; Muscular Atrophy, Spinal; Muscular Disorders, Atrophic; Neuromuscular Nondepolarizing Agents; Rocuronium; Sugammadex

Neuromuscular disorders like myotonic dystrophy (dystrophia myotonica or Steinert's disease) and spinal muscular atrophy are associated with perioperative complications related to muscle weakness. These patients have an increased sensitivity to non-depolarising neuromuscular blocking agents, which can lead to postoperative residual curarization (PORC) and its associated respiratory complications. Adequate reversal of neuromuscular blockade is essential to prevent this. Sugammadex is the first selective relaxant binding agent and it reverses rocuronium- and vecuronium-induced neuromuscular block. Two cases are reported in which the patients received sugammadex to reverse a rocuronium-induced neuromuscular block. Reversal of the rocuronium-induced neuromuscular block (NMB) in both cases was fast, effective and without recurarization, and no safety concerns were observed.

Topics: Adult; Androstanols; Female; gamma-Cyclodextrins; Humans; Middle Aged; Muscular Atrophy, Spinal; Myotonic Dystrophy; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Rocuronium; Sugammadex

Topics: Androstanols; Anesthesia, General; Anesthesia, Obstetrical; Cesarean Section; Female; Humans; Intubation, Intratracheal; Muscular Atrophy, Spinal; Neuromuscular Nondepolarizing Agents; Pregnancy; Pregnancy Complications; Rocuronium