A case where rocuronium was unable to achieve neuromuscular block immediately after sugammadex administration

We present a case where immediatemuscle relaxation was needed following
sugammadex administration. A 72 year-old female underwent surgery for a cerebral artery
aneurysm. Upon conclusion of the operation sugammadex (9.3 mg/kg) was administered
and the patient was noted to have left hemiplegia. Rocuronium (1.2 mg/kg 2 doses)
was given in order to gain neuromuscular block approximately 25 minutes after sugammadex
had been injected. Although TOF monitoring was not utilized in this case and assessing
residual muscular block was difficult, spontaneous respirations continued and
breathing had to be controlled with sevoflurane and remifentanil. Sugammadex is a
potent reversal agent for rocuronium-induced neuromuscular block, however, certain
situations require immediate neuromuscular blockade following sugammadex. In this case,
rocuronium was unable to induce neuromuscular blockade immediately after sugammadex
and that higher concentrations were necessary in addition to intravenous analgesics
and inhaled anesthetics.

The journal of medical investigation : http://medical.med.tokushima-u.ac.jp/jmi/index.html