Reversão de bloqueio muscular profundo com sugammadex após falha de intubação traqueal em sequência rápida: relato de caso

Fabiano Timbó Barbosa; Rafael Martins da Cunha

doi:10.1590/S0034-70942012000200015

Clinical Information

Reversão de bloqueio muscular profundo com sugammadex após falha de intubação traqueal em sequência rápida: relato de caso

Reversal of profound neuromuscular blockade with sugammadex after failure of rapid sequence endotracheal intubation: a case report

Fabiano Timbó Barbosa; Rafael Martins da Cunha

http://dx.doi.org/10.1590/S0034-70942012000200015 Braz J Anesthesiol, vol.62, n2, p.283-284, 2012

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Resumo

JUSTIFICATIVA E OBJETIVOS: O sugammadex é um agente reversor superseletivo do bloqueio neuromuscular utilizado para a reversão de rocurônio e vecurônio. Este relato descreve um caso clínico em que o sugammadex foi utilizado em paciente idosa imediatamente após uso de rocurônio. RELATO DO CASO: Paciente do sexo feminino, 88 anos, 34 kg, com fratura de fêmur foi submetida à anestesia geral após tentativa falha de raquianestesia. Optou-se por indução anestésica com propofol 1,5 mg.kg-1, rocurônio 1,2 mg.kg-1, fentanil 100 mcg e lidocaína 2 mg.kg-1. Não houve sucesso nas manobras para intubação traqueal nem no posicionamento da máscara laríngea. Optou-se pelo uso de sugammadex na dose de 16 mg.kg-1 com retorno da função respiratória. CONCLUSÕES: A dose recomendada pela literatura para o sugammadex em pacientes com bloqueio profundo, 16 mg.kg-1, foi utilizada nesta paciente com reversão rápida e eficaz do bloqueio neuromuscular permitindo que a paciente fosse submetida a outro procedimento para garantir a perviedade das vias aéreas sem comprometimento clínico de seu estado geral.

Palavras-chave

BLOQUEADOR MUSCULAR, COMPLICAÇÕES

Abstract

BACKGROUND AND OBJECTIVES: Sugammadex is a reversal agent that acts as a selective antagonist of neuromuscular blockade induced by rocuronium and vecuronium. This is a case report of an elderly female patient who had sugammadex just after rocuronium induction. CASE REPORT: An 88-year-old female patient, 34 kg, presented a femoral fracture and had to undergo general anesthesia after spinal anesthesia failure. Induction was performed with propofol 1.5 mg.kg-1, rocuronium 1.2 mg.kg-1, fentanyl 100 mcg, and lidocaine 2 mg.kg-1. There was no success in either tracheal intubation or laryngeal mask positioning maneuvers. The use of sugammadex at a dose of 16 mg.kg-1 was required and respiratory function returned to normal. CONCLUSION: Literature recommends sugammadex at a dose of 16 mg.kg-1 for patients with profound blockade. It was used in our patient with rapid and effective reversal of neuromuscular blockade allowing the patient to undergo another procedure to ensure the airway patency without clinical impairment of her general condition.

Keywords

Intraoperative Complications, Intubation, Cyclodextrin

References

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Reversão de bloqueio muscular profundo com sugammadex após falha de intubação traqueal em sequência rápida: relato de caso

Reversal of profound neuromuscular blockade with sugammadex after failure of rapid sequence endotracheal intubation: a case report

Fabiano Timbó Barbosa; Rafael Martins da Cunha

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