Sugammadex Rescue in Avoiding Intensive Care Unit Admission in an Octogenarian Undergoing Emergency Laparotomy.

Postlaparotomy management for elderly patients with underlying comorbidities is always a challenge because of poor cardiorespiratory reserves and prolonged effect of anesthetic drugs. For these reasons, such patients usually require intensive care unit (ICU) admission in the postoperative period. We report a case of an 85-year-old chronic smoker with controlled diabetes mellitus who needed an emergency laparotomy for a perforated gastric ulcer. Unfortunately, there was a shortage of ICU backup. With the successful conduct of an early surgery using combined general and regional anesthesia, the use of sugammadex (Bridion, Merck Sharp & Dohme Corp, Oss, the Netherlands) as a reversal agent, a skilled surgeon, and good postanesthesia care, the patient did not require ICU admission. He recovered fast and was discharged home 4 days after surgery. This case study aims to contribute to the literature on experience of a successful conduct of anesthesia in a high-risk geriatric patient when ICU facilities are limited.

Postpoliomyelitis Syndrome and Reversal With Sugammadex: A Case Report.

Postpolio syndrome (PPS) is a disabling process characterized by progressive muscle weakness and atrophy that typically emerges decades after an initial poliomyelitis infection. Although the exact incidence of PPS is unknown, it is estimated that 25% to 40% of all poliomyelitis survivors are affected. Patients with PPS may have increased sensitivity to numerous anesthetic agents including neuromuscular blocking drugs. A case report of a patient with PPS undergoing general anesthesia for a cystoscopy procedure is presented. Because of a previous general anesthetic using traditional muscle relaxant reversal of neostigmine, which resulted in prolonged paralysis (6-8 hours) and an intensive care unit admission, sugammadex was used in the cystoscopy procedure. Excellent results were achieved. Following extubation, the patient sustained adequate respiratory effort demonstrated by respiratory rate, end-tidal carbon dioxide, and oxygen saturation within normal limits. Sugammadex administration led to a markedly improved outcome for a patient with a disabling muscle-weakening neurologic disorder. Use of this medication may be of value to other anesthesia providers caring for patients with PPS in an operative setting.

Efficacy of Sugammadex in Preventing Skin Test Reaction in a Patient With Confirmed Rocuronium Anaphylaxis: A Case Report.

The curative role of sugammadex has been challenged in several observations of rocuronium-induced anaphylaxis because sugammadex may not completely encapsulate the molecule of rocuronium. In such conditions, rocuronium remains able to cause immunoglobulin E cross-linkage and the anaphylaxis mechanism can continue. We describe a case of rocuronium-induced anaphylaxis in which clinical improvement followed sugammadex administration. Intradermic skin tests confirmed rocuronium immunoglobulin E-mediated anaphylaxis but also showed intradermal injection of mixing in equal molecular ratio of sugammadex with rocuronium preventing rocuronium anaphylactic skin reaction. This observation demonstrates the efficacy of sugammadex to prevent rocuronium interaction with the skin immune system.