Effective reversal of muscle relaxation by rocuronium using sugammadex in a patient with myasthenia gravis undergoing laparoscopic cholecystectomy

: As myasthenia gravis affects neuromuscular transmission, these patients show various responses to neuromuscular blocking drugs. We report a successful use of the sugammadex in a myasthenic patient to reverse rocuronium-induced neuromuscular block. A 69-year-old woman was scheduled for laparoscopic cholecystectomy and total of rocuronium 20 mg was administered. After spontaneous recovery of T1, we administered sugammadex 200mg intravenously, reversing neuromuscular blockade to a train-of-four ratio (T4/T1) of 100% within 30 sec. Sugammadex can be used to reverse rocuronium-induced neuromuscular blockade in patients with myasthenia gravis, thereby avoiding the need for reversal with acetylcholinesterase inhibitors.