Abstract
Sugammadex, a recently developed selective relaxant binding agent, has the potential to transform the practice of anesthesia in patients with myasthenia gravis. Rocuronium was administrated to maintain train-of-four (TOF) counts of 2 until the end of intrathoracic maneuver in myasthenia gravis patients undergoing thymectomy. Intubation dosages of rocuronium were decreased, but maintenance dosages were not that different from non-myasthenic patients. Recovery of the TOF ratio to >90% was attained with 2 mg/kg of sugammadex. We can safely provide adequate muscle relaxation for the duration of surgery using sugammadex administration. However, the TOF ratio during the baseline in the case of fulminant myasthenia gravis was >100%. A TOF ratio of >90% does not always represent adequate muscle function of the pharyngeal or respiratory muscle. In addition, administration of rocuronium and sugammadex might become confusing factors in treating patients with myasthenia gravis. We should use rocuronium with caution for the maintenance of anesthesia.
