To the editor,

In our previous report, we described an awake and extubated patient suffering laryngospasm after administration of sugammadex 100 mg.¹ Here we report a case who was also awake and extubated without laryngospasm while receiving 50 mg of sugammadex two times with an interval of 1 min.

A 62-year-old female, with a height of 152 cm and weight of 70 kg (body mass index = 30.3), underwent an emergent laparoscopic cholecystectomy because of acute cholecystitis. She was classified as American Society of Anesthesiologists physical status III due to a medical history of hypertension, hyperthyroidism and obesity. General anesthesia was induced and maintained with propofol and remifentanil by target controlled infusion, 2% lidocaine 40 mg, and rocuronium 50 mg, dexamethasone 5 mg and was intubated with a Trachway. The operation was smooth and took about 70 min. Continuous infusion of propofol and remifentanil was discontinued as the procedure ended. No additional dose of rocuronium was administered. Neostigmine and glycopyrrolate were not administered because the patient could spontaneously breathe with a tidal volume of 400 mL. She told us that she couldn’t breathe well after extubation, and therefore, sugammadex 50 mg was prescribed intravenously (train-of-four [TOF] = 0.9). One minute later, the other dose of sugammadex was given. She breathed well and her tidal volume reached 600 mL after the management (TOF = 1). We fi gured out this strategy according to Dalton et al.,² who pointed out that correct dosage of sugammadex will quickly (within 2–3 min) reverse full neuromuscular blockade recovery as our recent experience,³ but may not ensure the restoration of a patent airway, and that laryngospasm might be related to the rapid and complete return of muscle tone. The patient was then sent to the post-anesthesia care unit for future care. An hour later, she was sent to general ward with stable vital signs.

In conclusion, we suggest that for awake and extubated patients complaining muscle weakness or not breathing well, sugammadex administration should be divided into lower doses and given with an interval.

Acknowledgments

We thank the patient for signing the informed consent for publication.

References