Sugammadex Use in the Reversal of Deep Neuromuscular Block in a Six-Year-Old Child after an Emergency Procedure in Ear, Nose and Throat Surgery Department

Tonsillectomy is a frequently performed procedure in children; its common postoperative complication is bleeding. We present a case report of a 6-year-old patient undergoing surgical haemostasis after an acute post-tonsillectomy bleeding. A rapid intubation sequence was performed to reduce the risk of blood inhalation and bronchospasm: fentanyl (1 mcg/kg) and propofol (3mg/Kg) were used for a rapid induction of anaesthesia, and rocuronium (1.2 mg/Kg) was used for neuromuscular block. Neuromuscular function was monitored using the TOF-Watch SX acceleromyography at the adductor thumb muscle. Surgical haemostasis lasted for 12 minutes after rocuronium administration, so the neuromuscular block was still deep (TOF 0, PTC 2). Sugammadex (4mg/Kg) was administered to allow a rapid reversal of the block. After the sugammadex bolus, we started a continuous monitoring with TOF-Watch SX until a TOF ratio of 0.9 was reached. A TOF ratio of 0.9 was reached 3 minutes after the administration of sugammadex. The patient was then extubated in the operating room and monitored in recovery room for 60 minutes. No further complications arose, either in the recovery room or in the ward.