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High‐dose rocuronium for rapid‐sequence induction and reversal with sugammadex in two myasthenic patients
Author(s) -
CASAROTTI P.,
MENDOLA C.,
CAMMAROTA G.,
DELLA CORTE F.
Publication year - 2014
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.12391
Subject(s) - medicine , sugammadex , rocuronium , anesthesia , plasmapheresis , muscle relaxant , rapid sequence induction , neuromuscular blockade , myasthenia gravis , neuromuscular junction , surgery , intubation , neuroscience , antibody , immunology , biology
The anesthetic management of patients affected by myasthenia gravis is usually challenging in elective surgery and even more so in emergency procedures. The difficulties involved are several‐fold, ranging from the choice of an appropriate muscle relaxant (i.e. one that enables safe and rapid airway management) to neuromuscular monitoring and normal muscular recovery. Additionally, optimizing patient conditions – either pharmacologically or with plasmapheresis – before intervention is well beyond the realm of possibility. We discuss the anesthetic management of two myasthenic patients undergoing emergency surgery (for sigmoid perforation and upper gastrointestinal bleeding respectively). In both cases, we opted for rapid‐sequence induction with high‐dose rocuronium to prevent inhalation of gastric contents. We also report on the implication of neuromuscular monitoring. We found that the rocuronium–sugammadex combination was a useful and effective option in the emergency setting.