Postoperative recurarization after sugammadex administration in two patients who received neoadjuvant chemotherapy: case reports and literature review

• Published in: Canadian journal of anesthesia Vol. 70; no. 9; pp. 1529 - 1538
• Main Authors: Li, Hui-xian, Zheng, Hui, Tang, Wei, Sun, Yong-kun, Zhang, Lin, Kong, Xiang-yi, Yan, Tao
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.09.2023; Springer Nature B.V
• Subjects: Anesthesiology; Cancer therapies; Cardiology; Case Reports; Case Series; Chemotherapy; Critical Care Medicine; Electrocardiography; gamma-Cyclodextrins - pharmacology; General anesthesia; Humans; Intensive; Intubation; Literature reviews; Medical personnel; Medical research; Medical schools; Medicine; Medicine & Public Health; Neoadjuvant Therapy; Neuromuscular Blockade - methods; Pain Medicine; Patients; Pediatrics; Pneumology/Respiratory System; Postoperative Period; Research centers; Sugammadex; Tumors; neoadjuvant chemotherapy; case report; deep neuromuscular block; sugammadex; recurarization
• ISSN: 0832-610X; 1496-8975
• DOI: 10.1007/s12630-023-02527-x

Background Preoperative neoadjuvant chemotherapy plays a critical role in multidisciplinary therapy for a variety of malignant tumours. Although oncologists consider myocardial injury to be the most concerning side effect of chemotherapy, unique chemotherapy-mediated skeletal muscular damage has received attention recently. Clinical features We report two unusual cases of postoperative delayed respiratory failure following administration of the recommended sugammadex dosage for patients undergoing lengthy operations with deep neuromuscular blockade (NMB) after neoadjuvant chemotherapy. Based on clinical outcomes, especially the comparison of muscle imaging results in patients at different treatment time points, we concluded that NMB recurrence had a possible correlation with neoadjuvant chemotherapy-induced muscular damage. Conclusion The early identification of neoadjuvant chemotherapeutic side effects on NMB could be instrumental for clinical safety, especially in cases of major surgery requiring deep NMB. Thus, the timing of NMB antagonism and the recommended dosage of sugammadex warrant special consideration in these patients. In addition to neuromuscular monitoring during the operation, a more extended and closer observation period in the postanesthesia care unit is warranted.