Neuromuscular block reversal with sugammadex in a morbidly obese patient with myasthenia gravis.

BACKGRAOUND: Myasthenia gravis is a rare immunological illness that impairs neuromuscular transmission. Myasthenic patients are usually hypersensitive to non-depolarising muscle relaxants, and reversal with neostigmine is rarely effective. We report the successful reversal of rocuroniuminduced neuromuscular block in a morbidly obese myasthenic patient.

CASE REPORT: A 38-year-old morbidly obese (body weight 160 kg, BMI 48.8 kg m⁻²) woman was scheduled for elective laparoscopic gastric banding. She was anaesthetised with propofol-based TIVA; intubation was facilitated by 24 mg of rocuronium. After spontaneous recovery of T1, she received 200 mg of sugammadex, which completely restored the NMT ratio (TOF=100%) within 2 min and 48 sec., and she was extubated. No postoperative complications were observed.

CONCLUSION

Sugammadex can be successfully used in myasthenic patients, allowing for the safe use of muscle relaxants in these patients.