Sugammadex to reverse residual neuromuscular blockade and facilitate neurologic examination in an adolescent trauma patient in the Pediatric ICU setting

Neuromuscular blocking agents (NMBAs) are frequently used in acute care scenarios to facilitate endotracheal in-tubation and permit effective mechanical ventilation. Despite their potential therapeutic efficacy, the immobil-ity may prevent clinical evaluation of a patient's neuro-logic status. In specific clinical scenarios such as when immediate tracheal extubation is indicated or assessment of neurologic status is required, prompt reversal of neu-romuscular blockade may be indicated. We present the novel use of sugammadex for reversal of NM blockade to allow for neurologic examination and tracheal extubation in an adolescent trauma patient. The pharmacology of sugammadex is reviewed, reports of its use in pediatric -aged patients discussed, and potential scenarios for use in the ICU setting presented.