Background: Myasthenia gravis (MG) is a challenge for anesthesia management. This report shows that the use of\nrocuronium-sugammadex is not free from flaws and highlights the importance of cholinesterase inhibitors management\nand neuromuscular block monitoring in the perioperative period of myasthenic patients.\nCase presentation: Myasthenic female patient submitted to general balanced anesthesia using 25 mg of rocuronium.\nUnder train-of-four (TOF) monitoring, repeated doses of sugammadex was used in a total of 800 mg without recovery of\nneuromuscular blockade, but TOF ratio (TOFR) was stabilized at 60%. Neostigmine administration led to the improvement\nof TOFR.\nConclusions: Although the use of rocuronium-sugammadex seems safe, we should consider their unpredictability in\nmyasthenic patients. This report supports the monitoring of neuromuscular blockade as mandatory in every patient,\nespecially the myasthenic ones.
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