Sugammadex in a parturient with myotonic dystrophy
| Authors | |
|---|---|
| Year of publication | 2013 |
| Type | Article in Periodical |
| Magazine / Source | British Journal of Anaesthesia |
| MU Faculty or unit | |
| Citation | |
| Doi | http://dx.doi.org/10.1093/bja/aet037 |
| Field | Gynaecology and obstetrics |
| Keywords | sugammadex; myotonic dystrophy; Caesarean Section; General Anaesthesia |
| Description | Myotonic dystrophy is a chronic, slowly progressing, highly variable, inherited multisystemic disease. It is characterized by wasting of the muscles (muscular dystrophy), cataracts, heart conduction abnormalities, endocrine changes, slow gastric and bowel emptying, and myotonia. Patients with myotonic dystrophy show myotonic responses to succinylcholine and neostigmine, and increased sensitivity to non-depolarising muscle relaxants. We report two cases of a parturient with myotonic dystrophy scheduled for Caesarean Section under general anaesthesia, once in 2009 and once in 2011. Muscle relaxant anaesthetic management in 2009 consisted of rocuronium and waiting for spontaneous neuromuscular blockade recovery with arteficial ventilation in the intensive care unit for 2 hours and 30 minutes postoperatively. In 2011, the same patient was indicated for the selective binding agent sugammadex ( 4 mg kg-1) to actively reverse deep neuromuscular blockade at the end of surgery. Train of Four ratio 0.9 was achieved in 2 minutes. There was no exacerbation of myotonia and no recurrence of muscle relaxation perioperatively in either case. These two obstetric cases provide evidence for the benefits of sugammadex in patients with myotonic dystrophy. We also suggest that it could be used in other patients with neuromuscular diseases. |