Prolonged neuromuscular blockade and insufficient reversal after sugammadex administration in cesarean section under general anesthesia: a case report

• Published in: JA clinical reports Vol. 5; no. 1; p. 28
• Main Authors: Moriwaki, Kuniaki, Kayashima, Kenji
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 11-04-2019; Springer Nature B.V; SpringerOpen
• Subjects: Anesthesiology; Case Report; Case reports; Cesarean section; Critical Care Medicine; Emergency Medicine; General anesthesia; Health risk assessment; Intensive; Medicine; Medicine & Public Health; Neuromuscular blockade; Pain Medicine; Pregnancy; Pregnancy; General anesthesia; Neuromuscular blockade; Cesarean section
• ISSN: 2363-9024; 2363-9024
• DOI: 10.1186/s40981-019-0248-8

Background
We present a rare case of prolonged neuromuscular blockade and insufficient reversal after sugammadex administration in a pregnant patient being treated with magnesium sulfate and nifedipine undergoing cesarean section under general anesthesia.
Case presentation
A 37-year-old woman at 34 weeks gestation, weighing 42.5 kg, and receiving magnesium sulfate 94 mg/kg for preeclampsia and nifedipine 20 mg, underwent cesarean section under general anesthesia for abruptio placentae. Her trachea was intubated after administering rocuronium 0.94 mg/kg. Postoperatively, sugammadex 4.7 mg/kg was administered at post-tetanic count 2, 163 min after rocuronium administration. However, 9 min after sugammadex administration, the train-of-four ratio only reached 0.7. Fifteen min after sugammadex administration, extubation was successfully performed when the train-of-four ratio reached 0.9 after administration of atropine 0.5 mg and neostigmine 1.0 mg.
Conclusions
Caution is required in pregnant women on high-dose magnesium sulfate with nifedipine, which may cause prolongation of neuromuscular blockade and insufficient reversal.