Sugammadex: Safe for Ambulatory Surgery

General Information

Case Report

Sugammadex: Safe for Ambulatory Surgery in Patients with ALS?

**Leyla Iyilikci, Prof, MD, Hale Aksu Erdost, MD^*, and Özge Kuzgun, MD**

^*Department of Anesthesiology, Dokuz Eylul University, Izmir, Turkey

Corresponding author

Hale Aksu Erdost, Specialist, Department of Anesthesiology, Dokuz Eylul University, Narlidere, Izmir, Turkey, Tel: +905323615722; E-mail: haleaksu78@yahoo.com

Received Date: 11^th February 2015

Accepted Date: 13^th March 2015

Published Date: 16^th March 2015

Citation

Karaoglan LL, Erdost HA, Kuzgun O (2015) Sugammadex: Safe for Ambulatory Surgery in Patients with ALS? Enliven: J Anesthesiol Crit Care Med 2(4): 010.

Copyright

@ 2015 Dr. Hale Aksu Erdost. This is an Open Access article published and distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.

Amyotrophic lateral sclerosis (ALS) is an autosomal- dominant disease which characterized by degeneration of upper and lower neurons. Sugammadex, is an agent acts encaplulating steroidal muscular relaxant to form a stable compel, thereby reduction of free concentration of the muscle relaxant from the plasma, which provides rapidly recovery from neuromuscular blocage effect. This complex of sugammadex and muscle relaxant is freely excreted through the kidneys. Sugammadex in recent years frequently has been used, with neuromuscular disease patients, who require neuromuscular blocage in the implimentation of general anesthesia. But in ambulatory surgery it is hard to use muscle relaxant in patients with a neuromuscular disease. In this case report, we described general anesthesia administration and use of sugammadex – rocuronium in a patient with ALS in ambulatory surgery.

Introduction

Amyotrophic lateral sclerosis (ALS) is an autosomal- dominant disease which characterized by degeneration of upper and lower neurons [1]. Sugammadex, is an agent acts encaplulating steroidal muscular relaxant to form a stable compel, thereby reduction of free concentration of the muscle relaxant from the plasma, which provides rapidly recovery from neuromuscular blocage effect. This complex of sugammadex and muscle relaxant is freely excreted through the kidneys [2]. Sugammadex in recent years frequently has been used, with neuromuscular disease patients, who require neuromuscular blocage in the implimentation of general anesthesia. But in ambulatory surgery it is hard to use muscle relaxant in patients with a neuromuscular disease. In this case report, we described general anesthesia administration and use of sugammadex – rocuronium in a patient with ALS in ambulatory surgery.

Case Description

A 51 year-old, 80 kg man was scheduled for percutan endoscopic gastrostomi (PEG) at department of gastroentorology. He was diagnosed with ALS 4 years prior, and has been replaced diaphragmatic pace which hadn’t been efficient. He has tracheostomi cannula and spontan intermitan ventilation by homoventilator at home. His preoperative physical examination and laboratory results –which were complete blood count, biochemistry, coagulation parameters- and chest radiogram, ECG were normal.

In operation room after non-invasive blood pressure, pulse oximeter analysis, and ECG monitoring 0.5 mg/kg propofol IV administered twice, but it wasn’t efficant for preparing patient for mouth holder. In order to perform the procedure we decided to administer general anesthesia. We applied 80 mg propofol and 0.3 mg/kg rocuronium IV but it wasn’t sufficent to open the mouth, so rocuronium completed to 0.6 mg /kg dose. Procedure maintained aproxiemetly 15 min by the time SPO₂ was around 96-99. After procedure 2 mg/kg sugammadex and 0.2 mg anexate IV administration patient’s spontane eye movement was obtained. He was tranported to the PACU with homoventilator support.

Discussion

We used sugammadex and rocuronium safely in patient with ALS. Recent studies have shown patients with ALS are susceptible to non-depolarizing neuromuscular blockers [3]. ALS is not a common disease so there is not enough publication with these patients using general anesthesia management with non-depolarizing neuromuscular blocking agents. Wachi et al. [4] reported an 86 year-old patient administered general anesthesia with propofol remifentanil and 0.52 mg/kg rocuronium for elective colostomy to the ileus. Also Ohshita et al. [5] published a case report about a 31 year old woman patient with ALS, was scheduled for tracheotomy. They administered sugammadex for general anesthesia management with sucsess. But there is no published literature which used sugammadex for ambulatory surgery patients with neuromuscular diseases such as ALS.

Also in the literature there are case reports preferable anesthesic managements such as epidural anesthesia [6] or general anesthesia without muscule relaxant [7] in patients with ALS. In our case we had to use muscule relaxant for mouth opening and also we didn’t prefer central neuraxial block which is relatively contraindicated of exacerbating progression of disease pattern [8]. Patients with ALS anesthesia management should contain the least embroil with disease and provide the maximum conditions for operation and also adequate analgesia. In this case we showed that general anesthesia with rocuronium and sugammadex can be used safely with these patients for ambulatory surgery.