Delayed neuromuscular recovery after use of sugammadex in a patient with amyotrophic lateral sclerosis: a case report

Abstract

This case report describes delayed muscular recovery in a patient with amyotrophic lateral sclerosis (ALS) after general anesthesia using rocuronium and sugammadex. A 62-year-old woman with ALS with bulbar involvement underwent ureteroscopic ureterolithotomy. We performed standard general anesthesia using propofol, rocuronium and sevoflurane with standard and neuromuscular monitoring. Rocuronium was administered at a dose of 20 mg (0.38 mg/kg) to facilitate endotracheal intubation, and anesthesia was maintained with sevoflurane in the range of 1-3 vol%. After the procedure, 100 mg of sugammadex (1.92 mg/kg) was administered and a train-of-four (TOF) ratio > 0.9 was observed in 80 s. However, the muscle strength was not the same as the preoperative level and tidal volume was judged to be inadequate for extubation. No further improvement in muscle strength was observed after administration of an additional 100 mg of sugammadex. The patient was transferred to the intensive care unit and pressure support ventilation was applied. Muscle strength was checked periodically and tracheal extubation was performed based on complete neuromuscular recovery to preanesthetic level after 4 h.