Unexpected delayed reversal of rocuronium-induced neuromuscular blockade by sugammadex: A case report and review of literature

Table 1 Summary of previously reported cases about delayed recovery after sugammadex

Ref.	Patient data	Past history	Surgery (duration)	Total dose of muscle relaxants; total dose of sugammadex	Time to extubation from first dose of sugammadex	Possible causes of delayed recovery after sugammadex
Ortiz-Gómez et al[28], 2014	60 yr/Male (115 kg/175 cm)	HTN	Sigmoid colon resection (360 min)	SCC 100 mg + rocuronium 83 mg; 1120 mg	208 min	An extreme outlier with resistance to sugammadex
Altıparmak et al[35], 2019	58 yr/Female (75 kg)	HTN, CVD, PD	Hysterectomy (90 min)	Rocuronium 45 mg; 800 mg	30 min	PD
Brown et al[44], 2019	58 yr/Male (69 kg/170 cm)	Glaucoma	Robot-assisted laparoscopic prostatectomy (not mentioned)	Vecuronium 9 mg; 400 mg	27 min	High magnesium
Fernandes et al[33], 2019	27 yr/Female (110 kg/172 cm)	Myasthenia gravis	Laparoscopic cholecystectomy (not mentioned)	Rocuronium 20 mg; 800 mg	45 min	Myasthenia gravis
Moriwaki and Kayashima[23], 2019	37 yr/Female (42 kg/144 cm)	HTN, GDM; preeclampsia	C/S (95 min)	Rocuronium 40 mg; 200 mg	> 15 min	High magnesium, pregnancy
Hiramatsu et al[34], 2022	63 yr/Male (68 kg/164 cm)	RA, DM, Af, restrictive lung disease	Hip arthroplasty (273 min)	Rocuronium 50 mg; 1200 mg	18 h	CMTD type 1A
Kiss et al[37], 2013	25 yr/Male (BMI: 32)	Myasthenia gravis	Thymectomy (120 min)	Rocuronium 50 mg; 12 mg/kg	Not mentioned	Myasthenia gravis

HTN: Hypertension; DM: Diabetes mellitus; CVD: Cerebrovascular disease; PD: Parkinson’s disease; TV: Tidal volume; IBW: Ideal body weight; GDM: Gestational diabetes; RA: Rheumatoid arthritis; BMI: Body mass index; CMTD: Charcot-Marie-Tooth disease.