Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Case Report

Volume 9, Number 1, February 2018, pages 50-52

Use of Sugammadex in a Patient With Myotonic Dystrophy

**Table 1.** Previous Reports of Sugammadex Use in Patients With Myotonic Dystrophy
Author and reference	Patient demographics	Outcome and anesthetic care
DM: myotonic dystrophy; TIVA: total intravenous anesthesia; TOF: train of four.
Pickard et al [10]	A 14-month-old child with DM for endoscopic gastrostomy tube placement, orchidopexy, and division of tongue tie	General anesthesia with sevoflurane and fentanyl. Rocuronium (0.8 mg/kg) to facilitate endotracheal intubation. Fifty-seven minutes after rocuronium, no response of the TOF. Sugammadex (5 mg/kg) resulted in a TOF ratio of 96%. However, this fell to 60% and a second dose of sugammadex (5 mg/kg) was administered. The TOF ratio was 86% and remained stable. The patient’s trachea was extubated.
Stourac et al [11]	A 37-year-old woman with DM for cesarean section	Anesthetic induction and endotracheal intubation with propofol (2 mg/kg) and rocuronium (1 mg/kg). At the completion of the procedure (50 min), there were no twitches. Sugammadex (2 mg/kg) resulted in a TOF of 0.9 in 2 min and the patient’s trachea was extubated.
Petrovski et al [12]	A 43-year-old woman with DM for cystoscopy and colonoscopy	Anesthesia was induced with sevoflurane in oxygen supplemented with propofol. Endotracheal intubation was facilitated by rocuronium (50 mg). Although there was no residual neuromuscular blockade on the TOF, sugammadex (200 mg) was administered to ensure complete reversal. Her trachea was extubated without problems.
Baumgartner et al [13]	A 59-year-old man with DM for elective laparoscopy	Anesthesia was induced with alfentanil (1 mg) and propofol (100 mg). Endotracheal intubation with rocuronium (30 mg). Surgery was completed 46 min after rocuronium. No twitches on the TOF. Sugammadex (2 mg/kg) was administered and 4 min later, TOF revealed four equal twitches. Within 10 min, the patient’s trachea was extubated.
Matsuki et al [14]	A 24-year-old woman with DM for laparoscopic ovarian cystectomy	Anesthesia was induced and maintained with propofol and remifentanil. Repetitive TOF stimulation was applied followed by rocuronium (0.3 mg/kg) for endotracheal intubation. At the completion of surgery, T2 of the TOF was present and sugammadex (2 mg/kg) was administered. Within 2 min, the TOF ratio was 0.9. The patient’s trachea was extubated.
Gurunathan et al [15]	A 60-year-old, 70 kg man with DM for elective laparoscopic cholecystectomy	Anesthesia was induced with midazolam and propofol. Endotracheal intubation was facilitated by rocuronium (50 mg). After 45 min, there were no twitches on the TOF. Sugammadex (200 mg) was administered and within 30 s, there were four twitches without fade and the patient’s trachea was.
Mavridou et al [16]	A 40-year-old, 74 kg woman with DM for laparoscopic cholecystectomy and ovarian cystectomy	Anesthesia was induced with propofol (2 mg/kg) and rocuronium (30 mg). TOF was applied and endotracheal intubation was facilitated by rocuronium (30 mg). Anesthesia was maintained with propofol and remifentanil. After 90 min, there was a reappearance of T2 on TOF. Sugammadex (2 mg/kg) was administered and within 2 min, the TOF was 1. Opioid reversal was necessary, but the trachea was successfully extubated.

Table 1. Previous Reports of Sugammadex Use in Patients With Myotonic Dystrophy

Author and reference

Patient demographics

Outcome and anesthetic care

DM: myotonic dystrophy; TIVA: total intravenous anesthesia; TOF: train of four.

Pickard et al [10]

A 14-month-old child with DM for endoscopic gastrostomy tube placement, orchidopexy, and division of tongue tie

General anesthesia with sevoflurane and fentanyl. Rocuronium (0.8 mg/kg) to facilitate endotracheal intubation. Fifty-seven minutes after rocuronium, no response of the TOF. Sugammadex (5 mg/kg) resulted in a TOF ratio of 96%. However, this fell to 60% and a second dose of sugammadex (5 mg/kg) was administered. The TOF ratio was 86% and remained stable. The patient’s trachea was extubated.

Stourac et al [11]

A 37-year-old woman with DM for cesarean section

Anesthetic induction and endotracheal intubation with propofol (2 mg/kg) and rocuronium (1 mg/kg). At the completion of the procedure (50 min), there were no twitches. Sugammadex (2 mg/kg) resulted in a TOF of 0.9 in 2 min and the patient’s trachea was extubated.

Petrovski et al [12]

A 43-year-old woman with DM for cystoscopy and colonoscopy

Anesthesia was induced with sevoflurane in oxygen supplemented with propofol. Endotracheal intubation was facilitated by rocuronium (50 mg). Although there was no residual neuromuscular blockade on the TOF, sugammadex (200 mg) was administered to ensure complete reversal. Her trachea was extubated without problems.

Baumgartner et al [13]

A 59-year-old man with DM for elective laparoscopy

Anesthesia was induced with alfentanil (1 mg) and propofol (100 mg). Endotracheal intubation with rocuronium (30 mg). Surgery was completed 46 min after rocuronium. No twitches on the TOF. Sugammadex (2 mg/kg) was administered and 4 min later, TOF revealed four equal twitches. Within 10 min, the patient’s trachea was extubated.

Matsuki et al [14]

A 24-year-old woman with DM for laparoscopic ovarian cystectomy

Anesthesia was induced and maintained with propofol and remifentanil. Repetitive TOF stimulation was applied followed by rocuronium (0.3 mg/kg) for endotracheal intubation. At the completion of surgery, T2 of the TOF was present and sugammadex (2 mg/kg) was administered. Within 2 min, the TOF ratio was 0.9. The patient’s trachea was extubated.

Gurunathan et al [15]

A 60-year-old, 70 kg man with DM for elective laparoscopic cholecystectomy

Anesthesia was induced with midazolam and propofol. Endotracheal intubation was facilitated by rocuronium (50 mg). After 45 min, there were no twitches on the TOF. Sugammadex (200 mg) was administered and within 30 s, there were four twitches without fade and the patient’s trachea was.

Mavridou et al [16]

A 40-year-old, 74 kg woman with DM for laparoscopic cholecystectomy and ovarian cystectomy

Anesthesia was induced with propofol (2 mg/kg) and rocuronium (30 mg). TOF was applied and endotracheal intubation was facilitated by rocuronium (30 mg). Anesthesia was maintained with propofol and remifentanil. After 90 min, there was a reappearance of T2 on TOF. Sugammadex (2 mg/kg) was administered and within 2 min, the TOF was 1. Opioid reversal was necessary, but the trachea was successfully extubated.