Table 3 Summary of case reports on the use of sugammadex in patients with myopathies (n = 17)
From: Use of sugammadex in patients with neuromuscular disorders: a systematic review of case reports
Author/year | Country | Patient characteristics | Disease | Type of surgery; Duration of surgery | Anesthetic agents | NMBA | NM monitoring | Dose of sugammadex & results of NM monitor | Postoperative course |
|---|---|---|---|---|---|---|---|---|---|
Baumgartner, 2010 | Australia | 59/M; 75 kg | Classic severe myotonic dystrophy | Elective laparoscopy; 46 min | Propofol, alfentanil for induction followed by maintenance with fentanyl boluses sevoflurane | 30 mg (0.4 mg/kg) rocuronium given after intubation | Qualitative neuromuscular monitoring | Sugammadex 150 mg; Pre reversal TOF count: 0 with myotonic response to tetany; Post reversal TOF count: 4 equal twitches (4 min) | Extubated end of surgery (within 10 min of sugammadex dose) |
Matsuki, Y et al., 2011 | Japan | 24/F; 75 kg; 160 cm. | Myotonic dystrophy | Laparoscopic ovarian cystectomy; N.R. | Propofol, remifentanil induction followed by maintenance with propofol, remifentanil infusion | Rocuronium 0.3 mg/kg followed by 0.1 mg/kg with the appearance of 4th twitch | Acceleromyography (TOF-Watch SX®) | Sugammadex 2 mg/kg; Pre reversal TOF count: 2; Post reversal TOF: 0.9 (<  2 min) | Extubation at the end of surgery |
Mavridou et al., 2011 | Greece | 40/F; 74 kg; 160 cm; BMI: 28.9 kg/m2 | Myotonic dystrophy | Laparoscopic cholecystectomy and right ovarian cystectomy; 90 min | Propofol induction followed by propofol, remifentanil infusion with oxygen/air | Rocuronium 30 mg (0.4 mg/kg) | Acceleromyography (TOF-Watch SX®) | Sugammadex 2 mg/kg; Pre reversal TOF count: 2; Post reversal TOF ratio: 1.0 (2 min) | Mechanically ventilated for around 25 min due to pethidine induced respiratory depression, which was reversed with naloxone; Uneventful extubation; No complications thereafter. |
Petrovski, 2011 | Australia | 43/F; BMI: 55 kg/m2 | Myotonic dystrophy | First surgery: Cystoscopy & colonoscopy; 90 min Second surgery: urological procedure; 180 min | First surgery: Propofol and sevoflurane/oxygen induction followed by maintenance with desflurane/oxygen/air with fentanyl. Second surgery: Details not reported, other than 200 mcg fentanyl | First surgery: Rocuronium 50 mg for intubation; Second surgery: Rocuronium 50 mg + Cisatracurium 4 mg | Qualitative neuromuscular monitoring | First surgery: Pre reversal TOF count 4; Sugammadex 200 mg; Post reversal TOF: N.R. Second surgery: Pre reversal TOF count:4; Reversal with Neostigmine 2.5 mg & Glycopyrollate 0.4 mg. Post reversal TOF: strong 4 twitches, however clinical signs of inadequate muscle strength recovery | First surgery: Uneventful extubation; Second surgery: Failed extubation, requiring 3 h of ventilation and postoperative lung infection. |
Suzuki et al., 2012 | Japan | 75 yr/M | Dermatomyositis | Open reduction of fracture elbow; 25 min | Propofol, fentanyl induction followed by maintenance with sevoflurane, remifentanil infusion and fentanyl boluses | Rocuronium 0.6 mg/kg | Acceleromyography (TOF-Watch SX®) | Sugammadex 2 mg/kg; Pre reversal TOF count: 1; Post reversal TOF: 0.9 (5.75 min). | Uneventful extubation and recovery |
Kashiwai et al., 2012 | Japan | 37/F; 55 kg; 154 cm | Myotonic dystrophy | Open resection of ovarian tumor | General anesthesia with fentanyl and propofol target- controlled infusion followed by maintenance with propofol, remifentanil infusions and intermittent epidural ropivacaine | Rocuronium 1 mg/kg followed by a subsequent bolus of 0.2 mg/kg | Acceleromyography (TOF-Watch SX®) | Sugammadex 2 mg/kg; Pre reversal TOF count: 2; Post reversal TOF: 0.9 (1.5 min) | Uneventful extubation and recovery |
Carron et al., 2013 | Italy | 67/F; 60 kg, 155 cm; BMI: 25 kg/m2 | Polymyosits with Sjogren’s syndrome | Laparoscopic sigmoid resection for diverticulitis; 210 min | Propofol, fentanyl induction followed by maintenance with desflurane and remifentanil | Rocuronium 0.9 mg/kg bolus followed by additional boluses to a total dose of 220 mg | Acceleromyography (TOF-Watch SX®) | Sugammadex 4 mg/kg; Pre reversal TOF count: 0, PTC: 1; Post reversal TOF ratio: 1.1(1.5 min) | Uneventful extubation and recovery |
*Stewart et al., 2013 | Australia | 38/F; 76 kg; 165 cm; BMI: 27.9 kg/m2 | Myotonic dystrophy | Laparoscopic cholecystectomy; 65 min | Propofol, remifentanil induction followed by maintenance with propofol and remifentanil infusion, oxygen / air | Rocuronium 35 mg (0.47 mg/kg); Rapid sequence induction with cricoid pressure | Kinemyography TOF monitor (M-NMT, Datex Ohmeda, Finland) | Sugammadex 200 mg (2.7 mg/kg); Pre reversal TOF count: 2; Post reversal TOF: 0.9 (5 min) | Uneventful extubation and recovery; Post-operative monitoirng in intensive care unit |
Stourac et al., 2013 | Czech Republic | ? 32/F; 38 weeks gestation | Myotonic dystrophy | Elective cesarean section; 55 min | Propofol induction followed by maintenance with sevoflurane | Rocuronium 1 mg/kg | Acceleromyography (TOF-Watch SX®) | Sugammadex 4 mg/kg; Pre reversal TOF count: 0; Post reversal TOF ratio: 0.9 (2 min) | Uneventful extubation and recovery, both mother and child |
Wefki Abdelgawwad Shousha et al., 2014 | Italy | 25/M; BMI: 25.6 kg/m2 | Duchenne Muscular dystrophy | Open cholecystecomy; 240 min | Propofol, fentanyl induction followed by maintenance with fentanyl, sevoflurane/oxygen/air | Rocuronium 10 mg to facilitate rapid sequence intubation followed by 5 mg every 45 min. | Acceleromyography (TOF Guard) | Sugammadex 150 mg; Pre reversal TOF ratio: 0.25; Post reversal TOF ratio: 0.9 (10 min) | Uneventful extubation and recovery |
Shimauchi et al., 2014 | Taiwan | 54/M; 54 kg, 167 cm; BMI: 19.4 kg/m2 | Becker’s muscular dystrophy | Laparoscopic cholecystectomy; 92 min | Fentanyl, midazolam induction; maintenance with propofol, remifentanil infusion, oxygen/air | Rocuronium 20 mg (0.4 mg/kg) followed by bolus to a total dose of 30 mg | Acceleromyography (TOF-Watch SX®) | Sugammadex 100 mg (2 mg/kg); Pre reversal TOF ratio: 0.2; Post reversal TOF ratio: 1.0 (2 min) | Uneventful extubation and recovery |
Gurunathan & Duncan, 2015 | Australia | 60/M; 70 kg | Myotonic dystrophy | Laparoscopic cholecystectomy; 45 min | Propofol, midazolam, Remifentanil infusion for induction followed by maintenance with propofol and remifentanil infusion | Rocuronium 50 mg | Qualitative neuromuscular monitoring | Sugammadex 200 mg (approx 3 mg/kg); Pre reversal TOF count: 0; Post reversal TOF count: 4 twitches (0.5 min) | Uneventful extubation and recovery |
Kendigelen et al., 2015 | Turkey | 52/M; 75 kg | Dermatomyositis | Ileostomy; 110 min | Propofol, remifentanil induction followed by maintenance with remifentanil infusion along with sevoflurane/oxygen/air | Rocuronium 0.6 mg/kg followed by 10 mg bolus | Acceleromyography (TOF-Watch SX®) | Sugammadex 2 mg/kg (150 mg); Pre reversal TOF ratio: 0.40; Post reversal TOF ratio: 0.9 (1 min) | Uneventful extubation and recovery |
Kosinova et al., 2016 | Czech Republic | 27/F; 90 kg; 39+ 4 weeks gestation | Becker’s myotonia congenita | Elective caesarean section; around 40 min | Propofol target controlled infusion, sufentanil | Rocuronium 1 mg/kg | Acceleromyography (TOF-Watch SX®) | Sugammadex 4 mg/kg; Pre reversal TOF: 0; Post reversal TOF: 0.98 (2 min 15 s) | Uneventful extubation and recovery |
Creaney et al., 2018 | Ireland | 25/F; 61 kg; 146 cm; BMI: 28.6 kg/m2; 30+ 6 weeks gestation | Congenital muscular dystrophy | Elective caesarean section; N.R. | Intravenous dexmedetomidine slow bolus followed by maintenance infusion throughout the procedure. Propofol 180 mg induction followed by a maintenance of propofol target controlled infusion; humidified high flow nasal oxygen | Rocuronium 1 mg/kg | Qualitative neuromuscular monitoring | Sugammadex 12 mg/kg in total; Pre reversal TOF count: 0; Post reversal TOF count: 4 (5 min) | Transferred to intensive care unit with dexmedetomidine infusion and extubated to non-invasive ventilation later, with pre-pregnancy BiPAP settings achieved in 24 h. |
Teixeira et al., 2019 | Portugal | 37/M; 65 kg; 173 cm | Myotonic dystrophy type 1 (Steinert disease) | Laparoscopic cholecystectomy; 60 min | Propofol and remifentanil target-controlled infusion for induction and maintenance | Rocuronium 25 mg (0.04 mg/kg) | Acceleromyography | Sugammadex: 150 mg (appr 2.3 mg/kg); Pre reversal TOF count: 2; Post reversal TOF count: 4, ratio: 0.96 (< 5 min) | Uneventful extubation and recovery |
Mangla et al., 2019 | USA | 46/F; 63 kg; 170 cm | Myotonic dystrophy | Robotic assisted laparascopic total abdominal hysterectomy and bilateral salpingo-oophorectomy; 3 h | Propofol induction followed by maintenance with fentanyl bolus, propofol and remifentanil infusions | Rocuronium 30 mg (0.48 mg/kg) | Qualitative neuromuscular monitoring (orbicularis oculi muscle) | Sugammadex 240 mg (3.8 mg/kg); Pre reversal TOF count: 0 (only weak post-tetanic counts were present); Post reversal TOF count:? 4 (not clearly stated) (10 min) | Uneventful extubation and recovery |