Reversal of prolonged rocuronium neuromuscular blockade with sugammadex in an obstetric patient with transverse myelitis

Abstract A 38-year-old wheelchair-bound primigravida with transverse myelitis presented at 38 weeks of gestation for elective caesarean section. Transverse myelitis, which is characterised by bilateral inflammation of the spinal cord and myelin destruction, is associated with myopathy, autonomic dys...

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Bibliographic Details
Published in:International journal of obstetric anesthesia 2010-07, Vol.19 (3), p.333-336
Main Authors: Weekes, G, Hayes, N, Bowen, M
Format: Article
Language:English
Subjects:
Adult
Androstanols - adverse effects
Androstanols - antagonists & inhibitors
Anesthesia & Perioperative Care
Anesthesia, General
Anesthesia, Obstetrical
Caesarean section
Cesarean Section
Female
gamma-Cyclodextrins - therapeutic use
Humans
Infant, Newborn
Male
Myelitis, Transverse - complications
Neuromuscular Blockade - adverse effects
Neuromuscular Nondepolarizing Agents - adverse effects
Neuromuscular Nondepolarizing Agents - antagonists & inhibitors
Obstetrics and Gynecology
Paralysis - complications
Pregnancy
Pregnancy Complications - therapy
Rocuronium
Sugammadex
Transverse myelitis
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Summary:Abstract A 38-year-old wheelchair-bound primigravida with transverse myelitis presented at 38 weeks of gestation for elective caesarean section. Transverse myelitis, which is characterised by bilateral inflammation of the spinal cord and myelin destruction, is associated with myopathy, autonomic dysreflexia and pulmonary aspiration. Regional anaesthesia was contraindicated in this case as the patient had undergone two previous lumbar spinal fusion procedures. Rocuronium 1.2 mg/kg was used to facilitate rapid intubating conditions. The caesarean section proceeded uneventfully, but even after administration of neostigmine the patient exhibited prolonged neuromuscular blockade. After 3 h and 15 min sugammadex was obtained to reverse neuromuscular blockade; the drug was not stocked in our hospital. Sugammadex 4 mg/kg resulted in complete reversal of blockade after 2 min. We believe that myopathy associated with transverse myelitis led to the prolonged duration of action of rocuronium. Sugammadex is a relatively new drug with few reported side effects. In this case it was used to reverse neuromuscular blockade and prevented prolonged postoperative ventilatory support.
ISSN:0959-289X
1532-3374
DOI:10.1016/j.ijoa.2010.03.009