Respiratory Arrest after Postoperative Extubation in a Myasthenic Patient who Received Sugammadex to Reverse Neuromuscular Blockade

Authors

  • Gisoon Park Yonsei University Wonju College of Medicine
  • Jae Chan Choi Yonsei University Wonju College of Medicine
  • Myung Ha Kim

DOI:

https://doi.org/10.24203/ajpnms.v6i4.5540

Keywords:

Myasthenia gravis, Myasthenic crisis, Thymectomy, Sugammadex

Abstract

Postoperative myasthenic crisis is common after thymectomy; the incidence ranges from 12 to 34%. Several factors are known to predict myasthenic crisis and increased risk necessitating postoperative mechanical ventilation, but incomplete postoperative reversal cannot be prevented perfectly. Sugammadex is a medicine that reverses neuromuscular blockade, and can be used to facilitate the return of spontaneous respiration in myasthenic patients. It was recently reported that myasthenic patients rapidly recovered neuromuscular function when sugammadex was used. An 81-year-old, 49 kg woman diagnosed with myasthenia gravis one month previously was admitted for intravenous immunoglobulin G treatment and thymectomy. After thymectomy the patient suffered a myasthenic crisis and respiratory arrest, despite administration of sugammadex to reverse the neuromuscular blockade.

This case suggests that more careful and strict evaluation and management should be conducted perioperatively in myasthenic patients, and that the recovery time (time to obtain a train-of-four [TOF] value > 0.9) and spontaneous breathing trial results should be obtained to accurately predict the success of spontaneous breathing.

Author Biographies

Gisoon Park, Yonsei University Wonju College of Medicine

Resident of Anesthesiology, Department of Anesthesiology and Pain Medicine

Jae Chan Choi, Yonsei University Wonju College of Medicine

Professor of Anesthesiology, Department of Anesthesiology and Pain Medicine, Brain Research Group

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Published

2018-12-15

How to Cite

Park, G., Choi, J. C., & Kim, M. H. (2018). Respiratory Arrest after Postoperative Extubation in a Myasthenic Patient who Received Sugammadex to Reverse Neuromuscular Blockade. Asian Journal of Pharmacy, Nursing and Medical Sciences, 6(4). https://doi.org/10.24203/ajpnms.v6i4.5540