Emergency Sugammadex Reversal in an 850-G Premature Infant: A Case Report

Abstract

Sugammadex is a novel reversal agent for the neuromuscular blocking agents rocuronium and vecuronium; it has been shown to rapidly and completely reverse neuromuscular blockade for rocuronium and vecuronium, even when the blockade is profound. We present the case of a 2-week-old, 850-g infant born at 25 weeks' gestation, who presented to the operating room for exploratory laparotomy and repair of ileal atresia. Anesthesia was induced and neuromuscular blockade with 1.2 mg/kg of rocuronium was administered. The neonate experienced rapid oxyhemoglobin desaturation and progressively became very difficult to mask ventilate. Direct laryngoscopy failed to result in successful intubation of the trachea and ventilation became impossible. To reverse the effects of rocuronium, 16 mg/kg of sugammadex was administered. Immediately after, the infant resumed spontaneous ventilation and was able to maintain adequate oxyhemoglobin saturation between 90% and 95% with supplemental oxygen. To our knowledge, this is the first report of successful reversal of neuromuscular blockade, with sugammadex, in an emergent situation after failure to intubate/ventilate an extremely low birth weight infant.

Sugammadex in Emergency Situations

“…In addition, the time to achieve a respiratory rate of less than four per minute after reversal with sugammadex may be as long as 12 min in 5% of all types of patients. Nevertheless, case reports of effective rescue in neonates who successfully recovered from a CICV situation without tracheostomy have been published [ 17 ]. Additional consideration should include the preparation time and sufficient dosage of sugammadex in the operating room [ 15 , 18 ].…”