Accidental epidural administration of sugammadex and ramosetron - A case report -

Background: Wrong-route administration of intravenous (IV) medications into the epidural space is a rare but potentially harmful event in anesthetic practice. Although various agents have been inadvertently injected via the epidural route, there have been no previous reports involving sugammadex or ramosetron.Case: We report the accidental epidural injection of sugammadex (200 mg) and ramosetron (0.3 mg) in a 69-year-old female under general anesthesia with thoracic epidural analgesia. Errors were recognized within 5 min. As the patient exhibited no immediate adverse effects, emergence from anesthesia proceeded with IV sugammadex administration. Six hours later, the patient developed mild right triceps weakness and bilateral C8 dermatomal tingling, which improved on postoperative day two. The patient was discharged without any neurological sequelae.Conclusions: Although the outcome was benign, this incident underscores the potential risks of wrong-route drug delivery and highlights the need for vigilance and preventive strategies in perioperative medication management.