Ewha Med J.  2017 Oct;40(4):159-163. 10.12771/emj.2017.40.4.159.

Dyspnea due to Residual Neuromuscular Blockade in Elderly Patient with Unrecognized Pre-existing Unilateral Vocal Cord Paralysis

• Lim CH
• Kim YJ
• Kim JH
• Jeong JS

• KMID: 2393720
• DOI: http://doi.org/10.12771/emj.2017.40.4.159

Abstract

Muscle relaxation using neuromuscular blocking agent is an essential process for endotracheal intubation and surgery, and requires adequate recovery of muscle function after surgery. Residual neuromuscular blockade is defined as an insufficient neuromuscular recovery that can be prevented by confirming train-of-four ratio >0.9 using objective neuromuscular monitoring. Sugammadex, a novel selective relaxant-binding agent, produces rapid and effective reversal of rocuronium-induced neuromuscular blockade. We report a case of the residual neuromuscular blockade accompanying dyspnea and stridor after general anesthesia in an unrecognized pre-existing symptomless unilateral vocal cord paralysis patient, who had experienced the disappearance of dyspnea and stridor after administration of sugammadex.

Keyword

Delayed emergence from anesthesia; Vocal cord paralysis; Sugammadex

MeSH Terms

Aged*
Anesthesia, General
Delayed Emergence from Anesthesia*
Dyspnea*
Humans
Intubation, Intratracheal
Muscle Relaxation
Neuromuscular Blockade
Neuromuscular Monitoring
Respiratory Sounds
Vocal Cord Paralysis*

Figure

• 

  Fig. 1 The left vocal cord paralysis observed with flexible laryngoscopy in the postanesthetic care unit. Right vocal cord observed adducted (A: arrow), abducted (B: arrow) movement but left vocal cord observed paralysis.

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