Abstract
BackgroundDrugs administered subcutaneously have delayed onset and prolonged duration of action versus those given intravenously. Since the duration of action of rocuronium is prolonged in patients with renal dysfunction, subcutaneous administration of rocuronium to such patients might significantly prolong its effect.Case presentationA 51-year-old female with chronic renal failure was accidentally administered 1.04 mg/kg rocuronium subcutaneously. Marked prolongation of onset and duration of action of rocuronium were detected on acceleromyography. Slow development of the neuromuscular block was still observed at 100 min after injection. Administration of 4.5 mg/kg sugammadex at 140 min after rocuronium injection facilitated recovery from a train-of-four (TOF) count of 2 to a TOF ratio of 100% within 5 min. No symptoms of postoperative recurarization and upper airway obstruction were observed.ConclusionNeuromuscular monitoring is necessary to evaluate the progress and depth of neuromuscular block, particularly when rocuronium is inadvertently administered subcutaneously.
Highlights
ConclusionNeuromuscular monitoring is necessary to evaluate the progress and depth of neuromuscular block, when rocuronium is inadvertently administered subcutaneously
Drugs administered subcutaneously have delayed onset and prolonged duration of action versus those given intravenously
The pharmacodynamic profiles of subcutaneously administered rocuronium are unclear, its duration of action would be significantly prolonged in patients with renal failure because it is partially excreted via the kidneys [3]
Summary
Neuromuscular monitoring is necessary to evaluate the progress and depth of neuromuscular block, when rocuronium is inadvertently administered subcutaneously.
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