RT Book, Section
A1 Kruidering-Hall, Marieke
A1 Campbell, Lundy
A2 Katzung, Bertram G.
A2 Vanderah, Todd W.
SR Print(0)
ID 1176972993
T1 Skeletal Muscle Relaxants
T2 Basic & Clinical Pharmacology, 15e
YR 2021
FD 2021
PB McGraw-Hill
PP New York, NY
SN 9781260452310
LK accessmedicine.mhmedical.com/content.aspx?aid=1176972993
RD 2024/04/16
AB CASE  STUDYAn  80-kg  35-year-old  woman  with  a  BMI  of  32  is  undergoing  right  knee  surgery  for  a  meniscus  tear.  The  surgeon  and  the  patient  both  request  general  anesthesia  for  the  procedure.  In  addition  to  obesity,  the  patient  has  hypertension  (treated  with  hydrochlorothiazide),  insulin-dependent  diabetes,  and  she  takes  an  oral  contraceptive  pill.  She  has  no  known  drug  allergies.  Her  physical  exam  is  remarkable  only  for  obesity  and  a  Mallampati  class  3  airway  (indicating  extremely  limited  space  from  tongue  base  to  roof  of  mouth  and  probable  difficulty  in  intubating).  Because  of  her  diabetes  and  risk  for  delayed  gastric  emptying,  you  elect  to  use  endotracheal  intubation  to  protect  her  airway  during  the  procedure.After  induction  of  anesthesia  with  propofol,  you  administer  a  dose  of  rocuronium  to  achieve  skeletal  muscle  relaxation  and  to  facilitate  endotracheal  intubation.  Once  fully  relaxed,  you  attempt  direct  laryngoscopy  but  are  unable  to  visualize  her  airway.  You  make  changes  to  the  patient’s  position,  and  use  a  different  technique,  but  you  are  still  unable  to  perform  intubation.You  switch  back  to  bag/mask  ventilation,  but  it  has  now  become  more  difficult  to  achieve  adequate  tidal  volumes.  You  decide  to  reverse  the  neuromuscular  blockade  and  wake  the  patient.  (1)  What  agents  could  be  used  to  reverse  the  neuromuscular  blockade?  (2)  What  would  be  the  most  appropriate  agent  to  use  in  this  scenario?  (3)  What  problems  may  occur  with  your  chosen  agent?