Abstract
Rocuronium is a non-depolarizing aminosteroidal neuromuscular blocking agent that is widely used in general anesthesia. Its effects may be prolonged in patients with renal disease, especially renal failure, due to reduced clearance of the drug. Sugammadex, a modified γ-cyclodextrin, is known to be a highly effective reversal agent for rocuronium-induced muscle relaxation. However, the administration of sugammadex for reversal of rocuronium-induced neuromuscular block in patients with renal disease is controversial. Recently, we administered rocuronium for neuromuscular blockade during the surgery of two patients with chronic renal failure, instead of cisatracurium, a benzylisoquinoline compound. Therefore, we had to administer sugammadex to ensure maximum alleviation of residual neuromuscular blockade risk after surgery. Although the effect of rocuronium was prolonged during surgery, sugammadex quickly and completely restored the response of train-of-four stimulation postoperatively. There were no residual neuromuscular block signs or symptoms observed in these patients throughout the postoperative period. In this report, we share our experience with these cases, and discuss the effectiveness and safety of sugammadex in the context of chronic renal failure. Keywords: Neuromuscular blockade; Neuromuscular monitoring; Renal failure; Residual neuromuscular blockade; Rocuronium; Sugammadex
Highlights
Since the number of patients with renal failure has steadily increased over the last decade, the response of these patients to neuromuscular blocking drugs remains an important concern in the field of anesthesiology [1]
The neuromuscular blockade (NMB) effect of rocuronium may be prolonged in patients with renal failure due to reduced clearance [9]
Kim et al [11] reported a markedly prolonged neuromuscular effect of 0.6 mg/kg rocuronium under desflurane anesthesia in patients with renal failure compared with patients with normal renal function
Summary
Since the number of patients with renal failure has steadily increased over the last decade, the response of these patients to neuromuscular blocking drugs remains an important concern in the field of anesthesiology [1]. In these patients, the effect of neuromuscular blocking drugs is usually prolonged, and can be very harmful. There are numerous reports on the prolonged effect of rocuronium in renal failure patients. The NMB effect of rocuronium 0.6 mg/kg under propofol anesthesia was reported to be markedly prolonged in young and elderly renal failure patients compared with patients with normal renal function [2]. Some studies have reported that sugammadex effectively and safely reverses rocuronium-induced moderate [4] or deep NMB [5,6], the use of sugammadex for rocuronium-induced NMB reversal in patients with renal disease is controversial
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