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Postoperative recurarization after sugammadex administration in two patients who received neoadjuvant chemotherapy: case reports and literature review

Récurarisation postopératoire après administration de sugammadex chez deux patient·es ayant reçu une chimiothérapie néoadjuvante : présentations de cas et revue de la littérature

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Canadian Journal of Anesthesia/Journal canadien d'anesthésie Aims and scope Submit manuscript

Abstract

Background

Preoperative neoadjuvant chemotherapy plays a critical role in multidisciplinary therapy for a variety of malignant tumours. Although oncologists consider myocardial injury to be the most concerning side effect of chemotherapy, unique chemotherapy-mediated skeletal muscular damage has received attention recently.

Clinical features

We report two unusual cases of postoperative delayed respiratory failure following administration of the recommended sugammadex dosage for patients undergoing lengthy operations with deep neuromuscular blockade (NMB) after neoadjuvant chemotherapy. Based on clinical outcomes, especially the comparison of muscle imaging results in patients at different treatment time points, we concluded that NMB recurrence had a possible correlation with neoadjuvant chemotherapy-induced muscular damage.

Conclusion

The early identification of neoadjuvant chemotherapeutic side effects on NMB could be instrumental for clinical safety, especially in cases of major surgery requiring deep NMB. Thus, the timing of NMB antagonism and the recommended dosage of sugammadex warrant special consideration in these patients. In addition to neuromuscular monitoring during the operation, a more extended and closer observation period in the postanesthesia care unit is warranted.

Résumé

Contexte

La chimiothérapie néoadjuvante préopératoire joue un rôle crucial dans le traitement multidisciplinaire de diverses tumeurs malignes. Bien que les oncologues considèrent les lésions myocardiques comme l’effet secondaire le plus inquiétant de la chimiothérapie, des lésions musculosquelettiques spécifiques induites par la chimiothérapie ont récemment fait l’objet d’une attention plus précise.

Caractéristiques cliniques

Nous signalons deux cas inhabituels d’insuffisance respiratoire postopératoire retardée suite à l’administration de la posologie recommandée de sugammadex chez des patient·es bénéficiant d’opérations prolongées avec blocage neuromusculaire (BNM) profond après une chimiothérapie néoadjuvante. Sur la base des résultats cliniques, en particulier de la comparaison des résultats d’imagerie musculaire chez les patient·es à différents moments du traitement, nous avons conclu que la récurrence du BNM avait une corrélation intéressante avec les lésions musculaires induites par la chimiothérapie néoadjuvante.

Conclusion

L’identification précoce des effets secondaires de la chimiothérapie néoadjuvante sur le BNM pourrait jouer un rôle déterminant dans l’innocuité clinique, en particulier en cas de chirurgie majeure nécessitant un BNM profond. Ainsi, le moment de l’antagonisme du BNM et la posologie recommandée de sugammadex nécessitent une attention particulière chez ces patient·es. En plus du monitorage neuromusculaire pendant l’opération, une période d’observation plus longue et plus étroite en salle de réveil est justifiée.

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Author contributions

Hui-xian Li and Tao Yan contributed to clinical data collection and paper drafting; Wei Tang contributed to CT image data collection and calculation; Yong-kun Sun, Xiang-yi Kong, and Lin Zhang performed the clinical analysis and the medical oncology and multidisciplinary consultations. Hui Zheng and Tao Yan helped to revise the draft. All the authors read and approved the final manuscript.

Disclosure

The authors declare that the research was conducted without any commercial or financial relationships that could be construed as a potential conflict of interest.

Funding statement

This work was supported by funding from the CAMS Innovation Fund for Medical Sciences (CIFMS, 2022-I2M-C&T-B-061), the Sanming Project of Medicine in Shenzhen, Cancer Pain Treatment and Perioperative Medical Team of Professor Li Sun in Cancer Hospital, Chinese Academy of Medical Science (SZSM201812069), the Fundamental Research Funds for the Central Universities (3332021099, 3332019050), and the Beijing Hope Run Special Fund for the Cancer Foundation of China (LC2021A18).

Editorial responsibility

This submission was handled by Dr. Stephan K. W. Schwarz, Editor-in-Chief, Canadian Journal of Anesthesia/Journal canadien d’anesthésie.

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Author notes

  1. Hui-xian Li, Hui Zheng, Wei Tang have contributed equally to this work.

Authors and Affiliations

  1. Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China

    Hui-xian Li MD, Hui Zheng MD & Tao Yan MD

  2. Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Wei Tang MD

  3. Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Yong-kun Sun MD

  4. Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia

    Lin Zhang MD

  5. Centre of Cancer Research, Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia

    Lin Zhang MD

  6. Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Xiang-yi Kong MD

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Li, Hx., Zheng, H., Tang, W. et al. Postoperative recurarization after sugammadex administration in two patients who received neoadjuvant chemotherapy: case reports and literature review. Can J Anesth/J Can Anesth 70, 1529–1538 (2023). https://doi.org/10.1007/s12630-023-02527-x

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