Key result
An obese patient experienced respiratory failure due to recurarization shortly after tracheal extubation, despite initial reversal of neuromuscular blockade with 200 mg of sugammadex.
Case Report (n=1)
This review addresses common clinical questions regarding the necessity and practice of neuromuscular monitoring to prevent postoperative residual curarization.
Suggests caution with sugammadex reversal in obese patients; leaves optimal dosing and monitoring open for prospective study.
The increase in mortality and morbidity associated with the use of muscle relaxants, is associated with a lack of clinical pharmacological knowledge of the drugs, and a lack of understanding the risk of postoperative residual curarization. This is due to the absence of standards for neuromuscular monitoring. Clinicians experienced in neuromuscular monitoring and using muscle relaxants in the clinic may have some queries regarding the monitoring: Why should neuromuscular monitoring be done? Are clinical tests really not effective? Why is it not good when I actually perform neuromuscular monitoring? Would using sugammadex not require neuromuscular monitoring? This review answers most of the questions that many clinicians have, and also forwards the knowledge required of clinicians.
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Sangseok Lee (2017) conducted a case report in Morbid obesity requiring general anesthesia (n=1). Sugammadex was evaluated on Recurarization / respiratory failure. An obese patient experienced respiratory failure due to recurarization shortly after tracheal extubation, despite initial reversal of neuromuscular blockade with 200 mg of sugammadex.
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