Reversal of rocuronium induced neuromuscular blockade using sugammadex in a patient with eclampsia treated by magnesium intraoperatively.

Abstract

Magnesium has been used frequently both as an anticonvulsant for preeclampsia and in the treatment of preterm labor. Magnesium also results in potentiation of the effects of neuromuscular blocking drugs, and attenuates their reversal with anticholinesterase [1]. Prolongation of the duration of the neuromuscular blockade (NMB) increases the risk of residual paralysis. Unlike anticholinesterase, sugammadex binds steroidal muscle relaxants by encapsulation, and it can rapidly and completely antagonize the action of the NMB. Theoretically, magnesium sulfate may reduce the efficacy of sugammadex [2]. We report a successful reversal of NMB with sugammadex in a patient with eclampsia who was treated with magnesium intraoperatively and showed incomplete reversal with anticholinesterase from rocuronium-induced NMB. A 30-year-old multipara (height 167 cm, weight 62 kg) at 27 weeks and 5 days of gestation visited the emergency room (ER) complaining of epigastric soreness, nausea, vomiting, and headache since the previous night. She had no specific medical history. Her blood pressure was 200/124 mmHg, heart rate 86 beats/min, and respiratory rate 24 breaths/min. According to a non-stress test, the fetal heart rate was 150 beats/min. After intravenous administration of hydralazine 5 mg, her blood pressure decreased to 140/100 mmHg. Forty minutes later, a seizure occurred. Diazepam 10 mg was immediately administered intravenously, and just an hour after the patient’s arrival at the ER, an emergency cesarean section was performed under general anesthesia.