Recurrence of the Neuromuscular Blockade after the Sugammadex Administration after Opioid-Induced Respiratory Depression: A Report of 3 Cases

Abstract

Three elderly patients received sugammadex after confirmation of train-of-four (TOF) stimulation at the end of the surgery. They presented opioid-induced respiratory depression accompanied by severe acidosis postoperatively. Even after the reversal of opioid intoxication with naloxone, the respiration did not recover, and TOF revealed recurrent paralysis. Two of three cases completely recovered after additional sugammadex administration, but remnant 1 case without sugammadex transferred to intensive care unit with intubated status. Even if the recommended dose of sugammadex is administered, there can be recurrent neuromuscular blockade by complicated reasons. Continuous quantitative neuromuscular monitoring may be needed to prevent these unusual situations.