Anaes Cases · Neuromuscular blockade & reversal
Can't intubate after a rocuronium rapid sequence — sugammadex rescue
The hot, time-pressured scenario — the unanticipated difficult airway after a high-dose rocuronium RSI, and the immediate reversal with sugammadex 16 mg/kg as the route back to spontaneous ventilation, alongside the difficult-airway algorithm.
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Prompt
A rapid sequence induction for a full-stomach patient uses rocuronium 1.2 mg/kg. The first laryngoscopy is a grade 4 view, and the patient cannot be intubated. Mask ventilation is maintaining the saturation. Manage the crisis and the role of sugammadex.
Presentation
A rapid sequence induction for a patient with a full stomach uses rocuronium 1.2 mg/kg for intubation. The first laryngoscopy gives a grade 4 view; the tube cannot be passed. Mask ventilation with cricoid pressure is maintaining an oxygen saturation in the low 90s. The rocuronium was given two minutes ago.
[8]References3ShowHide
- [8]Tran DT, Newton EK, Mount VA, Lee JS, et al. Rocuronium versus succinylcholine for rapid sequence induction intubation. Cochrane Database of Systematic Reviews, 2015.PMID 26512948
- [2]Hristovska AM, Duch P, Allingstrup M, Afshari A. Efficacy and safety of sugammadex versus neostigmine in reversing neuromuscular blockade in adults. Cochrane Database of Systematic Reviews, 2017.PMID 28806470
- [9]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.