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Restoration of Train-of-Four Ratio with Neostigmine After Insufficient Recovery with Sugammadex in a Patient with Myasthenia Gravis

Sugi, Yasuyuki MD; Nitahara, Keiichi MD, PhD; Shiroshita, Toyoo MD, PhD; Higa, Kazuo MD

doi: 10.1097/ACC.0b013e3182953053
Case Reports: Case Report

We present a patient with myasthenia gravis in whom sugammadex failed to restore the train-of-four ratio (TOFR) sufficiently. When the patient’s TOFR count had recovered to 2, we administered 2 mg/kg of sugammadex. However, the TOFR did not recover to the preoperative value. An additional 2 mg/kg of sugammadex also had no effect. We then administered 30 μg/kg of neostigmine which restored the TOFR to more than the preoperative value. We speculate that exacerbation of myasthenia symptoms during surgery interfered with recovery of TOFR after sugammadex administration.

From the Department of Anesthesiology, Fukuoka University Faculty of Medicine, Fukuoka, Japan.

Accepted for publication March 29, 2013.

Funding: None.

The authors declare no conflicts of interest.

Reprints will not be available from the author.

Address correspondence to Yasuyuki Sugi, MD, Department: Anesthesiology, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma Jonan-ku Fukuoka, 814-0180 Japan. Address e-mail to

© 2013 International Anesthesia Research Society
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