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Letter Case Reports
Sugammadex administration results in arousal from intravenous anaesthesia: a clinical and electroencephalographic observation.
Chazot et al. describe a 25 yo undergoing a Nissen fundoplication, receiving TCI propofol/remifentanil (targets of 2.3 ug/mL & 4 ng/mL respectively) along with rocuronium. The deep neuromuscular block was reversed with sugammadex 4 mg/kg and the patient awoke within 80 seconds (clinically and BIS > 90) despite TCI targets continuing. No awareness was noted.
summary- T Chazot, G Dumont, M Le Guen, C Hausser-Hauw, N Liu, and M Fischler.
- Br J Anaesth. 2011 Jun 1;106(6):914-6.
no abstract available
Notes
Chazot et al. describe a 25 yo undergoing a Nissen fundoplication, receiving TCI propofol/remifentanil (targets of 2.3 ug/mL & 4 ng/mL respectively) along with rocuronium. The deep neuromuscular block was reversed with sugammadex 4 mg/kg and the patient awoke within 80 seconds (clinically and BIS > 90) despite TCI targets continuing. No awareness was noted.
Daniel Jolley
Given the relatively low propofol TCI target (NB: 50% wake @ 1.07 mcg/mL and 50% orientated @ 0.95 mcg/mL), even in the presence of remifentanil, I wonder whether this is more a case of unrecognized light anaesthesia than sugammadex waking someone up.
Case in point, the demonstrated effect of rocuronium on BIS in awake volunteers: Response of bispectral index to neuromuscular block in awake volunteers
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