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. 2017;3(1):41.
doi: 10.1186/s40981-017-0111-8. Epub 2017 Aug 15.

A case in which a capnometer was useful for diagnosing laryngospasm following administration of sugammadex

Keito Kou  1 , Takeshi Omae  1 , Saiko Wakabayashi  1 , Sonoko Sakuraba  1
Affiliations

A case in which a capnometer was useful for diagnosing laryngospasm following administration of sugammadex

Keito Kou et al. JA Clin Rep. 2017.

Abstract

Background: Sugammadex has been reported to cause upper-airway obstruction, such as laryngospasm or bronchospasm. These two conditions are treated using different approaches, but the differential diagnosis is difficult.

Case presentation: We describe a case in which general anesthesia was administered via endotracheal intubation, in combination with brachial-plexus block, for arthroscopic surgical treatment of a rotator-cuff tear caused by recurrent shoulder dislocation. The total dose of rocuronium administered was 90 mg, and the last dose of 10 mg was given 15 min before the end of the surgery. Sugammadex was intravenously administered at 100 mg to reverse the effect of rocuronium after the operation ended. After extubation in this case, we placed a mask firmly around the patient's mouth, and thus, there was no air leakage around the mask. We detected upper-airway obstruction that was presumably attributable to administration of sugammadex. The end-tidal carbon dioxide (EtCO2) concentration was undetectable on a capnometer. Although 100% oxygen was administered at 10 L/min via a facemask, oxygen saturation (SpO2) decreased to approximately 70%. With suspected onset of laryngospasm, continuous positive airway pressure with 100% oxygen at 10 L/min was started at 30 cm H2O. The patient's airway obstruction resolved after a short time.

Conclusion: The use of a capnometer facilitated the diagnosis of laryngospasm and allowed us to administer appropriate treatment after administration of sugammadex.

Keywords: Bronchospasm; Capnometer; Continuous positive airway pressure; Rocuronium; Sugammadex.

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Conflict of interest statement

Written informed consent was obtained from the patient and his family to publish this case report and accompanying images.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Changes in end-tidal carbon dioxide and arterial oxygen saturation of pulse oxymetry after sugammadex administration. Event: ① intravenous injection of sugammadex, ② extubation, ③ disappearance of end-tidal carbon dioxide (EtCO2), ④ decline of arterial oxygen saturation, ⑤ start of continuous positive airway pressure
See this image and copyright information in PMC

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