Successful Reversal with Sugammadex of Deep Neuromuscular Block Caused by Rocuronium and Magnesium Sulfate in a Patient with H.E.L.L.P Syndrome

A 70 kg, previously healthy, 28-year-old primigravida was admitted to our delivery ward at 36 weeks of gestation. The patient was suffering from severe preeclampia with H.E.L.L.P (hemolysis, elevated liver enzymes and low platelets count) syndrome. She was treated with magnesium sulfate 4 g bolus followed by 2 g/h continuous infusion (her magnesium plasma levels were 5-6 mg%) and hydralazine but, since her clinical status was worsening (severe hypertension and decreasing platelets count from 80,000 to 40,000/µL), an urgent Caesarean delivery was planned. In view of the low platelet count it was decided to perform general anesthesia using a rapid-sequence induction with propofol 3 mg/kg and succinylcholine 1.5 mg/kg. Standard anesthetic monitoring included a nerve stimulator (TOF-Watch SX, Organon- Technika Boxtel, the Netherlands) with the active electrode attached over the ulnar nerve. Anesthesia was maintained with 1-2% isoflurane in a mixture of 50% oxygen/nitrous oxide. Fentanyl 100 mcg was administered after the baby was delivered and the umbilical cord was clamped. [More]