Multiple Recurarization Episodes After Sugammadex Reversal in Hyperthermic Intraperitoneal Chemotherapy: A Case Report.

Sugammadex reverses rocuronium-induced neuromuscular blockade via 1:1 molar encapsulation. Recurarization is rare when sugammadex is dosed as recommended. We report a 53-year-old woman undergoing hyperthermic intraperitoneal chemotherapy (HIPEC) who developed three sequential recurarization episodes despite an initial sugammadex dose (5.4 mg/kg), ultimately requiring 1400 mg cumulatively. HIPEC-associated hyperthermia and a prolonged rocuronium infusion likely promoted peripheral-to-central redistribution of rocuronium and overwhelmed free sugammadex in plasma. In patients with large cumulative rocuronium exposure or suspected altered pharmacokinetics, sugammadex dosing should account for total rocuronium administered rather than depth of neuromuscular blockade alone, alongside extended postoperative neuromuscular monitoring.