Failed reversal of neuromuscular blockade despite sugammadex: A case of undiagnosed pseudocholinesterase deficiency

Abstract

The management of an undetected pseudocholinesterase deficiency in a parturient who underwent urgent
cesarean section has been presented. After rapid sequence induction with succinylcholine, rocuronium
was used for maintenance of neuromuscular block. At the end of the operation neostigmine was given
to antagonize the residual block. Upon persistent prolonged neuromuscular blockade sugammadex was
administered. Probable reasons, drug interactions, the importance of suspecting pseudocholinesterase
deficiency and the need of neuromuscular monitoring have been argued in this case report.