ロクロニウム抵抗性疑いの患者に対してロクロニウムにマグネシウムを併用することにより容易に深い筋弛緩下で手術しえた症例

Magnesium Use Reduced the Dose of Rocuronium for Deep Neuromuscular Blockade in a Patient with Suspected Rocuronium Resistance：A Case Report

要旨

　60代，女性。両側横隔神経麻痺に対して胸腔鏡下横隔膜縫縮術を行ったが，ロクロニウム抵抗性により横隔膜処置に難渋した。再手術では，ロクロニウムにマグネシウムを併用することで容易に深い筋弛緩管理ができ，問題なく手術を完遂しえた。

　ロクロニウム抵抗性患者の筋弛緩管理の一手段になりうると考えられた。

　Rocuronium resistance has been frequently reported. Its presence makes achieving a deep neuromuscular blockade challenging, especially for diaphragm surgery. Some studies have suggested that magnesium has a sparing effect on non-depolarizing muscle relaxants and does not interfere with the efficacy of the recommended dose of sugammadex for neuromuscular blockade reversal. We describe the case of a woman in her 60s with bilateral phrenic nerve paralysis. She was scheduled for a thoracoscopic diaphragm plication, but her apparent rocuronium resistance to a dose of rocuronium exceeding 2 mg・kg⁻¹・hr⁻¹ made diaphragm manipulation difficult. In the reoperative surgery, a deep neuromuscular blockade was easily achieved with the addition of magnesium（a loading dose of 50 mg・kg⁻¹ followed by a continuous in fusion of 15 mg・kg⁻¹・hr⁻¹）, and the surgery was successfully completed. The addition of magnesium may be useful for neuromuscular management in patients with rocuronium resistance.