Sugammadex reversal of rocuronium-induced neuromuscular blockade in two types of neuromuscular disorders: Myotonic dystrophy and spinal muscular atrophy

Abstract

Neuromuscular disorders like myotonic dystrophy (dystrophia myotonica or Steinert's disease) and spinal muscular atrophy are associated with perioperative complications related to muscle weakness. These patients have an increased sensitivity to non-depolarising neuromuscular blocking agents, which can lead to postoperative residual curarization (PORC) and its associated respiratory complications. Adequate reversal of neuromuscular blockade is essential to prevent this. Sugammadex is the first selective relaxant binding agent and it reverses rocuronium- and vecuronium-induced neuromuscular block. Two cases are reported in which the patients received sugammadex to reverse a rocuronium-induced neuromuscular block. Reversal of the rocuronium-induced neuromuscular block (NMB) in both cases was fast, effective and without recurarization, and no safety concerns were observed.

Resumen

Las enfermedades neuromusculares como la distrofia miotónica (o enfermedad de Steinert) y la atrofia muscular espinal se asocian con las complicaciones perioperatorias relacionadas con la debilidad muscular. Estos pacientes presentan una hipersensibilidad a los bloqueantes neuromusculares no despolarizantes que podría derivar en curarización residual postoperatoria con complicaciones respiratorias. Para evitarlo conviene antagonizar satisfactoriamente el bloqueo neuromuscular (BNM). Sugammadex es el primer relajante selectivo y antagoniza los bloqueos neuromusculares por rocuronio y vecuronio. Se notifican dos casos donde los pacientes recibieron sugammadex para antagonizar un bloqueo neuromuscular provocado por rocuronio. El antagonismo de los BNM por rocuronio en ambos casos fue rápido, eficaz y sin recurarización, no se observaron preocupaciones de seguridad.