Effective Use of Sugammadex for Incomplete Pyridostigmine Reversal of Muscle Relaxation by Rocuronium: A Case Report

Anticholinesterase does not allow adequate reversal of the deep neuromuscular blockade (NMB) achieved using high doses of relaxants. A 71-year-old female patient (weight 70 kg, height 169 cm) was scheduled for a transurethral resection of a bladder tumor under general anesthesia. We administered rocuronium 30 mg (0.43 mg/kg) for tracheal intubation due to an estimated short surgical time. During the operation, an additional rocuronium 10 mg was injected. The surgical procedure ended abruptly 10 minutes after receiving the last dose of rocuronium. At the end of surgery, the patient received pyridostigmine as a reversal. However, residual NMB persisted, and neuromuscular monitoring did not show the expected degree of recovery. Sugammadex 2 mg/kg was used, and the patient experienced complete reversal from NMB in just 2 min.