Sugammadex and Reversal of Neuromuscular Block in Adult Patient with Duchenne Muscular Dystrophy

Duchenne’s muscular dystrophy (DMD) is the most common and severe form of myopathy. Patients with DMD are more sensitive to sedative, anesthetic, and neuromuscular blocking agents which may result in intraoperative and early postoperative cardiovascular and respiratory complications, as well as prolonged recovery from anesthesia. In this case report, we describe a 25-year-old male patient admitted for cholecystectomy under general anesthesia. We induced our anesthesia by oxygen, propofol, fentanyl, and rocuronium bromide. Maintenance was done by fentanyl, rocuronium bromide, sevoflurane, and O2. We report in this case the safety use of sugammadex to antagonize the neuromuscular block and rapid recovery in such category of patients. 1. Introduction Duchenne muscular dystrophy (DMD) is a rare genetic X-linked recessive disorder but it is one of the most frequent genetic conditions affecting approximately 1 in 3,500 male births worldwide. It is usually recognized between three and six years of age. DMD is characterized by weakness and wasting (atrophy) of the muscles of the pelvic area followed by the involvement of the shoulder muscles. As the disease progresses, muscle weakness and atrophy spread to affect the trunk and forearms and gradually progress to involve additional muscles of the body [1, 2]. The anesthetic management of these patients is complicated not only by muscle weakness but also by cardiac and pulmonary manifestations. However there is no definite recommendation for either general or regional anaesthesia. Succinylcholine and volatile anaesthetics have been best avoided because there is a risk of hyperkalemic cardiac arrest or severe rhabdomyolysis [3]. Some authors have suggested intubation and anesthesia without resorting to muscle relaxants, in order to avoid postoperative respiratory failure related to the usage of muscle relaxants and the other complications induced by acetylcholinesterase inhibitors. However, anesthesia without muscle relaxants might not always be suitable for some surgical procedures like such as in our patient [4]. Case reports in patients with myasthenia gravis document the successful use of sugammadex (six case reports). For other rare muscular diseases like Duchenne muscular dystrophy recent reports document the successful reversal of rocuronium with sugammadex in pediatric patients [5–9]. And in this case report we document the sugammadex safety in an adult Duchenne disease patient. 2. Case Presentation A 25-year-old male with DMD with a modified Barthel index of 23 (Barthel index is an ordinal scale used to