Use of Sugammadex after Neostigmine Incomplete Reversal of Rocuronium-Induced Neuromuscular Blockade

Neuromuscular blockers (NMB) have been used for more than half of a century in anesthesia and have always been a challenge for anesthesiologists. Until recently, the reversal of nondepolarizing neuromuscular blockers had only one option: the use of anticholinesterase agents. However, in some situations, such as deep neuromuscular blockade after high doses of relaxant, the use of anticholinesterase agents does not allow adequate reversal of neuromuscular blockade. Recently, sugammadex, a gamma-cyclodextrin, proved to be highly effective for reversal of NMB induced by steroidal agents. A female patient who underwent an emergency exploratory laparotomy after rapid sequence intubation with rocuronium 1.2mg.kg−1. At the end of surgery, the patient received neostigmine reversal of NMB. However, neuromuscular junction monitoring did not show the expected recovery, presenting residual paralysis. Sugammadex 2mg.kg−1 was used and the patient had complete reversal of NMB in just 2 minutes time. Adequate recovery of residual neuromuscular blockade is required for full control of the pharynx and respiratory functions in order to prevent complications. Adequate recovery can only be obtained by neuromuscular junction monitoring with TOF ratio greater than 0.9. Often, the reversal of NMB with anticholinesterase drugs may not be completely reversed. However, in the absence of objective monitoring this diagnosis is not possible. The case illustrates the diagnosis of residual NMB even after reversal with anticholinesterase agents, resolved with the administration of sugammadex, a safe alternative to reverse the NMB induced by steroidal non-depolarizing agents. O uso de bloqueadores neuromusculares (BNM) na prática anestésica já tem mais de meio século e sempre foi um desafio para os anestesiologistas. Até bem pouco tempo a reversão dos bloqueadores neuromusculares adespolarizantes só possuia uma opção: a utilização de anticolinesterásicos. No entanto em algumas situações como na presença de bloqueio neuromuscular profundo após o uso de altas doses do relaxante, o uso de anticolinesterásicos não possibilita a adequada reversão do bloqueio neuromuscular. Recentemente uma ciclodextrina gama mostrou-se altamente eficaz para a reversão do BNM de agentes esteroidais, o sugamadex. Paciente do sexo feminino, submetida à laparotomia exploradora de emergência após intubação em sequência rápida com uso de rocurônio 1,2mg.kg−1. Ao final da cirurgia a paciente foi descurarizada com neost