Murat KARCIOĞLU, Işıl DAVARCI, Kasım TUZCU, Yusuf Bolkan BOZDOĞAN, Suzan AYDIN, Leyla KEKEÇ

Neostigminin başarısız olduğu roküronyuma bağlı rezidüel kürarizasyonda Sugammadeks kullanımı

Nondepolarizan kas gevşetici ajanların etkilerinin uzamasına bağlı olarak gelişen postoperatifrezidüel kürarizasyon modern anestezide hala yaygın görülen ve hasta güvenliğine ciddi tehditoluşturan önemli bir problemdir. Anestezi sonrasında rezidüel nöromusküler blok, uygun şekildedöndürülmezse postoperatif pulmoner komplikasyonların gelişimini ve postoperatif mortaliteyiarttırır. Spinal kitle nedeniyle opere edilen Amerikan Anestezistler Derneği II risk grubuolgumuzda nöromusküler bloker olarak roküronyum kullanıldı. Operasyonun sonundaroküronyuma bağlı rezidüel nöromusküler bloğu döndürmek için neostigmin kullanılmasınarağmen hastada solunum yetmezliği gelişti. Kas gücü yetersiz olan hasta ajite, taşikardik, takipneikve tidal volümü düşüktü. Postoperatif rezidüel kürarizasyonu döndürmede neostigminin başarısızolması üzerine, hastaya modifiye γ-siklodekstrin yapısındaki 200 mg sugammadeks uygulandı.Nöromusküler bloğun hızlı ve etkili bir şekilde döndüğü tespit edildi. Sonuç olarak gelenekselantikolinerjik ajanların başarısız olduğu roküronyuma bağlı rezidüel kürarizasyonda sugammadekskullanımının güvenilir ve etkin olduğunu düşünüyoruz.

Sugammadex usage f or rocuronium caused residual curarization in which neostigmine f ailed

Postoperative residual curarization caused by prolonged effect of non-depolarizing neuromuscularblocking agents is still a serious, frequent and life threatening problem in modern anesthesia. Ifpostoperative residual neuromuscular block cannot be recovered properly, postoperativepulmonary complications and mortality may increase. We used rocuronium as a neuromuscularblocker in our American Society of Anesthesiologists II risked patient which was operated for aspinal mass. Respiratory failure was occurred in our patient despite the usage of neostigmine forrecovering neuromuscular block caused by rocuronium. The patient was tachycardic, tachypneic,the tidal volume was decreased and the muscle strength was weak. After the ineffectiveness ofneostigmine in recovering neuromuscular blockage, 200mg sugammadex which is a modified γ- cyclodextrin was given to the patient. We observed that neuromuscular blockage was recoveredrapidly and effectively. In conclusion, we think that using sugammedex is effective and safe inresidual curarization caused by rocuronium in which traditional anticholinergic agents are notsuccessful.

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