PMID- 34889149
OWN - NLM
STAT- MEDLINE
DCOM- 20220317
LR  - 20220317
IS  - 1940-5596 (Electronic)
IS  - 1089-2532 (Linking)
VI  - 26
IP  - 1
DP  - 2022 Mar
TI  - Unanticipated Profound Paralysis and Sugammadex Dosing Implications After 
      Videoscopic Thoracic Surgery.
PG  - 86-89
LID - 10.1177/10892532211059885 [doi]
AB  - A bedridden patient with empyema presented for thoracoscopic decortication. 
      During the procedure, despite a post-tetanic count (PTC) of 0 via calibrated 
      quantitative neuromuscular monitoring, persistent diaphragmatic movement impaired 
      operating conditions, so rocuronium was re-dosed. After surgery, the patient had 
      0 PTC. Sugammadex was titrated to achieve baseline neuromuscular strength, 
      monitoring the effect of each 200-mg dose. Ultimately, 1200 mg was required to 
      achieve baseline strength. We describe monitor troubleshooting, considerations 
      with unexpectedly deep neuromuscular blockade, the importance of routine 
      quantitative neuromuscular monitoring, and one strategy for sugammadex reversal 
      in patients with profound paralysis outside of the standard dosing guidelines.
FAU - McKittrick, Melissa L
AU  - McKittrick ML
AUID- ORCID: 0000-0003-4847-390X
AD  - Department of Anesthesiology, 12328Vanderbilt University Medical Center, 
      Nashville, TN, USA.
FAU - Lombard, Frederick W
AU  - Lombard FW
AD  - Department of Anesthesiology, 12328Vanderbilt University Medical Center, 
      Nashville, TN, USA.
LA  - eng
PT  - Journal Article
DEP - 20211210
PL  - United States
TA  - Semin Cardiothorac Vasc Anesth
JT  - Seminars in cardiothoracic and vascular anesthesia
JID - 9807630
RN  - 0 (Neuromuscular Nondepolarizing Agents)
RN  - 0 (gamma-Cyclodextrins)
RN  - 361LPM2T56 (Sugammadex)
SB  - IM
MH  - Humans
MH  - *Neuromuscular Blockade/methods
MH  - *Neuromuscular Nondepolarizing Agents
MH  - Paralysis
MH  - Sugammadex
MH  - *Thoracic Surgery
MH  - *gamma-Cyclodextrins
OTO - NOTNLM
OT  - critical care
OT  - intensive care unit
OT  - intraoperative assessment
OT  - minimally invasive surgery
OT  - monitoring
OT  - thoracic surgery
EDAT- 2021/12/11 06:00
MHDA- 2022/03/18 06:00
CRDT- 2021/12/10 08:40
PHST- 2021/12/11 06:00 [pubmed]
PHST- 2022/03/18 06:00 [medline]
PHST- 2021/12/10 08:40 [entrez]
AID - 10.1177/10892532211059885 [doi]
PST - ppublish
SO  - Semin Cardiothorac Vasc Anesth. 2022 Mar;26(1):86-89. doi: 
      10.1177/10892532211059885. Epub 2021 Dec 10.