Table 5 Summary of case reports on the use of sugammadex in patients with motor neuron diseases (n = 9)
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 |
|---|---|---|---|---|---|---|---|---|---|
Vilela et al., 2012 | Portugal | 61/M; 85 kg, 175 cm; BMI: 27.8 kg/m2 | Spinal muscular atrophy | Elective percutaneous atrial septal defect (ostium secundum) closure; 117 min | Propofol, remifentanil induction followed by maintenance with propofol, remifentanil infusion | Rocuronium 40 mg (0.47 mg/kg) | Acceleromyography (TOF-Watch SX®) | Sugammadex 170 mg (2 mg/kg); Pre reversal TOF ratio: 0.62, Post reversal TOF ratio: 0.90 (69 s) | Uneventful extubation and recovery |
Franco-Hernández et al., 2013 | Spain | 2 siblings; Case 1: 47/F Case 2: 43/F | Strumpell-Lorrain Disease/Familial spastic paraplegia | Case 1: Cholecystectomy; N.R. Case 2: Laparoscopic subtotal colectoy and ileostomy; N.R. | Propofol, midazolam, Fentanyl induction (both) followed by maintenance with sevoflurane, remifentanil infusion (Case 1) propofol and remifentanil infusion (Case 2) | Rocuronium 0.6 mg/kg; no further boluses | Quantitative neuromuscular monitoring | Sugammadex 2 mg/kg; Pre reversal: moderate neuromuscular blockade; Post reversal TOF ratio: > 0.9 | Uneventful extubation and recovery in both cases |
Kelsaka et al., 2013 | Turkey | 47/M; 70 kg | Amyotrophic lateral sclerosis (Lou Gehrig’s disease) | Fracture neck of humerus; 75 min | Propofol, remifentanil induction followed by maintenance with remifentanil infusion, sevoflurane/oxygen/air | Rocuronium 20 mg (0.29 mg/kg) for intubation; Additional 10 mg bolus during the procedure | Acceleromyography (TOF-Watch SX®) | Sugammadex 2 mg/kg; Pre reversal TOF > 0.9 with spontaneous breathing but difficulty in opening eyes; Post reversal TOF not stated; but increase in depth of breathing and able to open eyes spontaneously after 2 min. | Uneventful extubation and postoperative monitoring in intensive care unit |
aStewart et al., 2013 | Australia | 61/F; 40 kg; 162 cm; BMI: 15.2 kg/m2 | Spinal muscular atrophy | Combined approach tympanoplasty; 118 min | Propofol, remifentanil induction followed by maintenance with propofol and remifentanil, oxygen / air | Rocuronium 40 mg/kg (1 mg/kg); rapid sequence induction | Acceleromyography (TOF-Watch SX®) | Reversal was administered after 17 min to assist surgery. Sugammadex 160 mg (4 mg/kg); Pre reversal TOF ratio: 0, post-tetanic count 1; Post reversal TOF: 0.9 (2.8 min). | Uneventful extubation and recovery |
Takeuchi, R et al., 2014 | Japan | 62/M; 70 kg, 173 cm; BMI: 23.4 kg/m2 | Kennedy’s disease (Spinal bulbar muscular atrophy) | Frontal sinusectomy; N.R. | Propofol, remifentanil induction followed by maintenance with propofol and remifentanil infusion, oxygen / air and fentanyl bolus end of surgery | Rocuronium 40 mg (0.57 mg/kg) | Qualitative neuromuscular monitoring | Sugammadex 150 mg (2 mg/kg); Pre reversal TOF count: 1; Post reversal TOF count: 4 (3 min) | Extubation 5 min after sugammadex; Uneventful recovery |
Chang et al., 2014 | Korea | 47.M; 38 kg; 165 cm; BMI: 14 kg/m2 | Amyotrophic lateral sclerosis | Total thyroidectomy with cervical node dissection; anaesthesia time 405 min | Propofol, remifentanil target-controlled infusion for induction and maintenance oxygen / air and fentanyl bolus end of surgery | Rocuronium 0.3 mg/kg for intubation with subsequent boluses of 10 and 5 mg | Acceleromyography (TOF-Watch SX®) | Sugammadex 1 mg/kg; Pre reversal TOF: 0.98, but with inadequate tidal volume and difficulty in opening eyes spontaneously. Post sugammadex, adequate clinical signs of recovery from paralysis. | Uneventful extuation; Postoperative ICU monitoring for 4 days |
Chang et al., 2017 | Korea | 62/F; 52 kg; 167 cm; BMI: 18.6 kg/m2 | Amyotrophic lateral sclerosis | Ureteroscopic ureterolithotomy; 84 min | Propofol induction followed by maintenance with sevoflurane, oxygen/air. No details on opioids | Rocuronium 20 mg bolus (0.38 mg/kg) | Acceleromyography (TOF-Watch SX®) | Sugammadex 100 mg (1.92 mg/kg); Pre reversal TOF: 0.65; Post reversal TOF: > 0.90 (80 s). In spite of TOF > 0.9, additional 100 mg (1.92 mg/kg) sugammadex administered due to reduced tidal volume and muscle strength with no improvement. | Postoperative transfer to ICU and ventilated for 4 hours followed by uneventful extubation. |
Yoo et al., 2017 | Korea | Case 1: 54/M; 70 kg; 175 cm; BMI: 23 kg/m2 Case 2: 66/F; 40 kg; 154 cm; BMI: 17 kg/m2 | Case 1: Progressive muscular atrophy Case 2: Amyotrophic lateral sclerosis | Case 1: Removal of intramedullary nail left femur and plate left humerus; 160 min Case 2: Split thickness skin grafting lower limb; 60 min | Case 1 &2: Premedication with glycopyrollate. Propofol with lignocaine induction, continuous remifentanil infusion; maintenance with desflurane and fentanyl bolus at the end of surgery. | Case 1: Rocuronium 30 mg (0.43 mg/kg) for intubation and a subsequent 5 mg bolus. Case 2: Rocuronium 20 mg (0.5 mg/kg) for intubation and a subsequent 5 mg bolus. | Quantitative neuromuscular monitoring | Case 1: Sugammadex 200 mg (2.86 mg/kg). Pre reversal TOF: 0.15 Post reversal TOF 1.25 (3 min) Case 2: Sugammadex 200 mg (5 mg/kg). Pre reversal TOF: 0 Post reversal TOF 1.15 (4 min) | Case 1 and 2: Uneventful extubation and recovery |
Tada et al., 2019 | Japan | 54/F; 48 kg; 156 cm; BMI: 19.7 kg/m2 | Hereditary spastic paraplegia | Decompressive laminectomy; Duration of surgery: N.R. | Propofol, remifentanil for induction followed by maintenance with fentanyl boluses and remifentanil infusion with desflurane/oxygen/air | Rocuronium 20 mg for intubation followed by 20 mg rocuronium as boluses to a total of 40 mg | TOF -Watch (NIHON KOHDEN Corporation, Japan) | Sugammadex 100 mg (2 mg/kg); Pre reversal TOF: N.R. Post reversal TOF count: 4 (ratio > 0.9) | Uneventful extubation and recovery |