Reactions 1680, p302 - 2 Dec 2017 Residual neuromuscular blockade: case report A 60-year-old woman developed residual neuromuscular blockade following therapy with rocuronium bromide. The woman with thyroiditis and a solid tumour in the right thyroid lobe was hospitalised for surgery. She was premedicated with midazolam and anaesthesia was introduced with sufentanil, propofol, dexamethasone and ondansetron. She was ventilated sufficiently using a face mask and was administered rocuronium bromide 0.44 mg/kg with total dose of 30mg. After 90 seconds, an endotracheal tube was placed and the pressure controlled ventilation was initiated while anaesthesia was maintained with desflurane. Muscular relaxation was induced after IV administration of rocuronium bromide. An attempt was made to stimulate vagus nerve and recurrent laryngeal nerve. However, the amplitudes of neuromuscular signals were weak. This was considered to have happened due to technical malfunction. They checked all the wires and connections but the signals remained weak. After ruling out this possibility of technical malfunction, expansion of intraoperative monitoring was initiated to measure muscle relaxation by establishing a Train of Four (TOF) Watch on her right thumb. The TOF count was 2 while TOF ratio was 0 at 36 minutes after rocuronium injection which signified a residual muscular blockade of approximately 80 95%. The woman was administered sugammadex and the initial dose of rocuronium was reversed. After 38 minutes, TOF ratio was 0.99 and recurrent laryngeal nerve signals were increased. Resection of the right thyroid was completed and she was transferred to the intermediate care unit. No complications were observed during initial 24 hours after the surgery. On next day, she was transferred to a regular ward and on day 3 of surgery, she was discharged from the hospital. Author comment: "However, several factors could contribute to an absence of IONM, . . .the influence of non depolarizing neuromuscular blocking agents (NMBAs) on signal strength". "Studies have shown that preoperative administration of muscle relaxants, such as rocuronium, may influence the strength of evoked potentials". "In addition, the use of rocuronium in patients with renal failure or hepatic cirrhosis results in a prolonged duration of neuromuscular blockade." Marshall SD, et al. Failed vocalis muscle monitoring during thyroid surgery resulting from residual muscle relaxation. A and A Case Reports 9: 158, No. 5, Sep 2017. Available from: URL: http://doi.org/10.1213/XAA.0000000000000554 - Germany 803285007 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680
Reactions Weekly – Springer Journals
Published: Dec 2, 2017
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