Sugammadex for Rapid Intraoperative Reversal of Neuromuscular Blockade in a Neonate

Sugammadex is a novel pharmacologic agent for the reversal of neuromuscular blockade, which selectively encapsulates the neuromuscular blocking agent (NMBA) thereby effectively removing it from the plasma concentration. In contrast to acetylcholinesterase inhibitors, sugammadex is able to reverse even profound neuromuscular blockade occurring immediately after the administration of a NMBA. Given this clinical effect, it has been suggested for use in critical clinical situations where rapid reversal of neuromuscular blockade is required. We report the use of sugammadex to reverse neuromuscular blockade following difficulty with positive pressure ventilation after endotracheal intubation in a neonate with a tracheoesophageal fistula. The potential for its use in critical airway and ventilation scenarios is reviewed. J Med Cases. 2018;9(12):400-402 doi: https://doi.org/10.14740/jmc3213