Clinical evaluation of the C-MAC D-Blade videolaryngoscope in severely obese patients: a pilot study

2 mg h were given. Sugammadex 400 mg was also given, bringing the total to 16 mg kg. Again arterial pressure increased to 140/65 mm Hg and stabilized, the heart rate decreased to 90 beats min, and the bronchospasm relaxed. The operation was postponed. Methyprednisolone 100 mg was given and she was weaned off the epinephrine infusion over the next 10 h. Analysis of the blood samples supported a diagnosis of anaphylaxis. Immuno-assay identified the source as rocuronium. Screening 9 weeks later showed a positive response to rocuronium, mivacurium, and vecuronium, but not succinylcholine, pancuronium, atracurium, or cisatracurium. Povidone iodine, chlorhexidine, propofol, sufentanil, and sugammadex all tested negatively. The surgical procedure was then performed uneventfully under general anaesthesia without neuromuscular blocking agent. It seems logical to administer a dose of sugammadex sufficient to ensure a 1 to 1 ratio for every molecule of rocuronium. To achieve this, a theoretical sugammadex to rocuronium dose ratio of 3.57:1 is needed. In clinical practice, the evidence indicates that sugammadex 16 mg kg is needed to obtain a T4/T1 ratio .0.9 in ,3 min in the presence of profound neuromuscular block. Dosage is clearly an important issue, and it is proposed that for anaphylaxis, at least 16 mg kg of sugammadex should be given with the aim of isolating as many molecules of neuromuscular blocking agent as quickly as possible. Our case required a total dose of 16 mg kg before the improvement was maintained. In summary, the importance of this case lies in the apparent dose-dependent recovery from a proven case of rocuronium anaphylaxis. We suggest the adoption of a dose of sugammadex of at least 16 mg kg when the treatment of rocuronium anaphylaxis does not rapidly respond to standard measures.