The successful use of sugammadex and uneventful recovery from general anaesthesia in a patient with myotonic dystrophy

Gurunathan, Usha; Duncan, Gemma

doi:10.4103/0019-5049.156894

Cited by 8 publications

(4 citation statements)

References 3 publications

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“…It has the ability to reverse any depth of neuromuscular blockage by rocuronium. Gurunathan et al had also described successful anesthetic management in patient with DM with general endotracheal, propofol and remifentanil infusion, and sugammadex for reversal like we did in our case [30].…”

Section: Discussionsupporting

confidence: 67%

“…The longer duration could be attributed to increased sensitivity to muscle relaxant due to her underlying disease. Reversal with sugammadex was initially chosen over anticholinesterases as neostigmine has been found to cause incomplete reversal and depolarization in patients with DM [6, 11, 18, 26, 27, 30] but it was also indicated as our patient was in deep neuromuscular blockage at the end of the surgery as shown by the neuromuscular monitor. Sugammadex works by directly encapsulating, binding, and inactivating rocuronium.…”

Section: Discussionmentioning

confidence: 99%

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Myotonic Dystrophy and Anesthetic Challenges: A Case Report and Review

Mangla

Bais

Yarmush

2019

Case Reports in Anesthesiology

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Providing anesthesia to patients with myotonic dystrophy (DM) can be very challenging due to the multisystemic effects of the disease and extreme sensitivity of these patients to sedatives, opioids, and anesthetic agents. Other factors such as hypothermia, shivering, or mechanical or electric stimulation during surgery can precipitate myotonia which is difficult to abolish and can lead to further complications. Generally, local or regional anesthesia is preferred to avoid the complications associated with general anesthesia in this group. However there are several case reports of successful use of general anesthesia (with or without volatile agents and with or without opioids). These general anesthetic cases led to postoperative admission to the regular floor or ICU. We present a case of a woman with a history of DM who underwent robotic assisted laparoscopic hysterectomy under general anesthesia and was discharged home on the same day.

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Myotonic Dystrophy and Anesthetic Challenges: A Case Report and Review

Mangla

Bais

Yarmush

2019

Case Reports in Anesthesiology

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“…The correct position of the double lumen tube is essential for the conduction of thoracoscopic surgery. Still, the use of sugammadex in MD patients has been shown to be effective and induces rapid reversal of blocking agents [14,15]. Maintenance of anesthesia was with TIVA instead of inhaled anesthetics since volatile anesthetics relax skeletal muscle, exacerbating and potentiating neuromuscular blocking agents which would make breathing more difficult post-operatively in this case [16].…”

Section: Discussionmentioning

confidence: 99%

Video-Assisted Thoracoscopic Surgery in an Adult Patient with Myotonic Dystrophy: A Case Report and Review of the Literature

Braunold¹,

Mahajna²,

Barák³

2017

J Anesth Clin Res

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A 52 year old intellectually disabled woman with myotonic dystrophy type 1 and a history of malignant melanoma underwent an elective thoracoscopic neoplasm resection. Pre-operatively she had very poor pulmonary function tests with a vital capacity of 1.99 L. The operation was conducted under total i.v. anesthesia with a single dose of 20 mg rocuronium and one lung ventilation was achieved with left double lumen tube. At the end of the surgery the patient regain conciseness and was extubated. Following extubation the patient quickly deteriorated into type 2 respiratory failure with significant hypoxemia. She was alternately ventilated with face mask and breathing spontaneously for about 2 h until fully recovered.

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“…[ 13 ] Use of sugammadex makes the use of rocuronium possible in patients with neuromuscular disorders. [ 14 ] Controversy on the dose to be administered in morbidly obese patients still continues. The present recommendation is to administer sugammadex based on the actual body weight, but one study has compared the use of doses based on lean body weight, lean body weight +20% and lean body weight +40% and found the administration of lean body weight +40% to be better.…”

Section: Sugammadexmentioning

confidence: 99%

Reversal agents in anaesthesia and critical care

2015

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Despite the advent of short and ultra-short acting drugs, an in-depth knowledge of the reversal agents used is a necessity for any anaesthesiologist. Reversal agents are defined as any drug used to reverse the effects of anaesthetics, narcotics or potentially toxic agents. The controversy on the routine reversal of neuromuscular blockade still exists. The advent of newer reversal agents like sugammadex have made the use of steroidal neuromuscular blockers like rocuronium feasible in rapid sequence induction situations. We made a review of the older reversal agents and those still under investigation for drugs that are regularly used in our anaesthesia practice.

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The successful use of sugammadex and uneventful recovery from general anaesthesia in a patient with myotonic dystrophy

Cited by 8 publications

References 3 publications

Myotonic Dystrophy and Anesthetic Challenges: A Case Report and Review

Myotonic Dystrophy and Anesthetic Challenges: A Case Report and Review

Video-Assisted Thoracoscopic Surgery in an Adult Patient with Myotonic Dystrophy: A Case Report and Review of the Literature

Reversal agents in anaesthesia and critical care

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