The use of 3 sugammadex out of 5 reversal of during recovery of rocuronium-induced neuromuscular blockade in a patient with post-tonsillectomy hemorrhage: a case report

• Main Authors: Hee-Jong Lee, Kyo Sang Kim, Tae Yeon Kim, Jeoung Hyuk Lee, Miae Jeong
• Format: Article
• Language: English
• Published: Korean Society of Anesthesiologists 2014-07-01
• Series: Korean Journal of Anesthesiology
• Subjects: postoperative hemorrhage; rocuronium; sugammadex; tonsillectomy
• Online Access: http://ekja.org/upload/pdf/kjae-67-43.pdf

Post-tonsillectomy hemorrhage (PTH) is the most frequent complication of tonsillectomy, and occasionally results in a lethal outcome. A 21-year-old man (height 180 cm, weight 95 kg) was scheduled for a bilateral tonsillectomy and uvulopalatopharyngoplasty for treatment of obstructive sleep apnea. He required 5 rounds of general anesthesia due to recurrent PTH. The anesthesiologist used sugammadex a total of 3 times to achieve the successful reversal of the deep neuromuscular blockade (NMB) induced by rocuronium. After sugammadex 2 mg/kg was administered, the NMB was reversed in 2 minutes each time. Re-administration of rocuronium within a short time interval after sugammadex may result in unpredictable effects of neuromuscular blocking agents. Sugammadex made it possible to perform a rapid, complete reverse when the residual block was maintained by an incomplete reversal of anticholinesterase.