Use of Sugammadex in an octagenerian with Myaesthenia Gravis undergoing emergency laporotomy.

BACKGROUND: Myaesthenia Gravis is an autoimmune disorder that results in increased sensitivity to neuromuscular blockers. Anaesthesia and surgery in patients with Myaesthenia Gravis is associated with an increased incidence of complications, including post operative ventilation. We report the successful use of intra-operative train of four ratio monitoring and Sugammadex to reverse rocuronium induced neuromuscular blockade in an elderly octagenarian with Myaesthenia Gravis undergoing an emergency laporotomy.

CASE REPORT: An 87year old man with Myaesthenia Gravis underwent an emergency laporotomy for a perforated sigmoid diverticulum. Induction of anaesthesia was performed with 100μg of fentanyl, 120mg propofol and 25mg rocuronium. Intraoperative boluses of 5mg rocuronium were guided by train of four ratio of 50%. At the end of the procedure 4mg/kg of Sugammadex was given to reverse neuromuscular blockade as observed by return of four twitches on the train of four. He was then successfully extubated and did not require any post operative ventilation.

CONCLUSION: We report the successful use of intra-operative neuromuscular monitoring and Sugammadex to reverse rocuronium induced neuromuscular blockade in an elderly octagenarian with Myaesthenia Gravis undergoing emergency laporotomy.