Ultra-Rapid Reversal of Rocuronium-Induced Paralysis with Sugammadex in the Emergency Department

Abstract

Patients experiencing status epilepticus may require intubation to protect their airway and prevent aspiration.1Rocuronium is a steroid-based, nondepolarizing neuromuscular blocking agent (NMBA) commonly used for rapid sequence intubation (RSI) in the emergency department. The need for reversal of neuromuscular blockade after RSI is unusual; however, if electroencephalogram (EEG) equipment is not readily available, rocuronium reversal allows the ED physician to assess if a patient is still seizing. Sugammadex is a novel, selective agent that reverses the paralytic effects of steroidal NMBA.2–8At present, sugammadex dose recommendations are based on actual body weight (ABW). We present a case of an obese patient in status epilepticus who was given sugammadex after rocuronium-induced neuromuscular blockade in RSI.