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{
    "pk": 1548,
    "title": "Extreme Paralysis Following Rocuronium Administration in a Myasthenia Gravis Patient: A Case Report",
    "subtitle": null,
    "abstract": "<p class=\"p1\" style=\"margin-bottom: 7.2px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-stretch: normal; font-size: 10.5px; line-height: normal; font-family: Arial; color: rgb(0, 0, 0);\"><b>Introduction: </b>The use of paralytics during rapid sequence intubation (RSI) in patients with myasthenia gravis (MG) remains a controversial topic in emergency medicine. Due to fewer functional acetylcholine receptors, these patients can be both sensitive and resistant to different types of neuromuscular blocking agents (NMBA). Their atypical sensitivity to non-depolarizing NMBAs such as rocuronium can increase both the duration and depth of paralysis after its use at typical RSI doses. However, the extent of rocuronium’s prolonged duration of effect in patients with MG has yet to be quantified in an emergency department setting.</p><p class=\"p1\" style=\"margin-bottom: 7.2px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-stretch: normal; font-size: 10.5px; line-height: normal; font-family: Arial; color: rgb(0, 0, 0);\"><b>Case Report: </b>We describe a case wherein a full RSI dose of 1.2 milligrams per kilogram of rocuronium led to a prolonged 232-minute duration of paralysis in a patient with MG. This sustained paralysis was suspected but only confirmed after the patient received the reversal agent sugammadex. Once administered, an acute change in neurologic function was seen, and the patient was emergently taken to the operating room for neurosurgical intervention.</p><p class=\"p1\" style=\"margin-bottom: 7.2px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-stretch: normal; font-size: 10.5px; line-height: normal; font-family: Arial; color: rgb(0, 0, 0);\"><b>Conclusion: </b>When intubating patients with MG, many emergency physicians are aware that using paralytics during RSI provides several challenges. If not properly dose-reduced, rocuronium may exert its paralytic effects for up to four hours in patients with MG. This unique case highlights the importance of personalizing care for this patient population before, during, and after RSI.</p>",
    "language": null,
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "case report; rapid sequence intubation; myasthenia gravis; rocuronium"
        },
        {
            "word": "paralytic"
        }
    ],
    "section": "Case Reports",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/0c3997m1",
    "frozenauthors": [
        {
            "first_name": "Kelsey",
            "middle_name": "",
            "last_name": "Billups",
            "name_suffix": "",
            "institution": "Medical University of South Carolina, Department of Pharmacy, Charleston, South Carolina",
            "department": ""
        },
        {
            "first_name": "Charlotte",
            "middle_name": "",
            "last_name": "Collins",
            "name_suffix": "",
            "institution": "Medical University of South Carolina, Department of Emergency Medicine, Charleston, South Carolina",
            "department": ""
        },
        {
            "first_name": "Aimee",
            "middle_name": "",
            "last_name": "Weber",
            "name_suffix": "",
            "institution": "Medical University of South Carolina, Department of Neurosurgery, Charleston, South Carolina",
            "department": ""
        }
    ],
    "date_submitted": "2023-07-19T17:16:22.869000+02:00",
    "date_accepted": "2023-07-19T17:28:32.368000+02:00",
    "date_published": "2023-08-14T18:00:00+02:00",
    "render_galley": null,
    "galleys": [
        {
            "label": "PDF",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/uciem_cpcem/article/1548/galley/1129/download/"
        }
    ]
}