Sugammadex for treatment of postoperative residual curarization in a morbidly obese patient

摘要

Small degrees of postoperative residual curarization increase the incidence of critical respiratory events (CREs) in the postanesthesia care unit (PACU). Certain patients, especially morbidly obese subjects, may be more susceptible to CREs, and prompt treatment is required when the situation occurs. This was the case in our patient who provided written consent for the publication of this report. A 44-yr-old woman (height 177 cm, weight 160 kg, body mass index 51 kgm~(-2)) received a propofol and remifentanil general anesthesia for a laparoscopic sleeve gastrectomy. Her neuromuscular function was monitored by acceleromyography (AMG) (TOF-Watch~R, Organon Teknik, Ireland) at the adductor pollicis muscle. After anesthesia induction, we used calibration mode 1 on the TOF-Watch, which yielded a train-of-four (TOF) ratio of 1.06. Rocuronium 70 mg was given to facilitate tracheal intubation, followed by intermittent doses of 10 mg to maintain a TOF ratio < 0.5 (100 mg iv total). At the end of the uneventful 85-min surgical procedure, remifentanil was discontinued and the propofol infusion was tapered.