Reversal of Vecuronium-induced Neuromuscular Blockade with Sugammadex in a Child with Moebius Syndrome after Accidental Extubation

Abstract

Sugammadex chemically encapsulates rocuronium and vecuronium, thereby rapidly terminating the neuromuscular blockade induced by these agents. Although the experience with the use of sugammadex in children under 2 years of age is limited, it may be considered in specific clinical contexts. We present a case where spontaneous efficient respiratory effort was resumed after reversal of vecuroniuminduced neuromuscular blockade with sugammadex in a child. A 21-month-old boy with a history of Moebius syndrome and obstructive sleep apnea needing night time noninvasive ventilation support was scheduled for adenotonsillectomy and bilateral myringotomy. Tracheal intubation was anticipated to be difficult and so it was performed using a videolaryngoscope. In the postoperative period the child remained intubated in the intensive care unit sedated and with a continuous infusion of vecuronium. On day 3 accidental extubation occurred. As it was considered an urgent situation, flumazenil, naloxone and sugammadex 2 mg.kg-1 were administered with rapid return of spontaneous respiration and consciousness, obviating the need of unnecessary airway manipulation and the inherent risks.