Postpoliomyelitis Syndrome and Reversal With Sugammadex: A Case Report

Postpolio syndrome (PPS) is a disabling process characterized by progressive muscle weakness and atrophy that typically emerges decades after an initial poliomyelitis infection. Although the exact incidence of PPS is unknown, it is estimated that 25% to 40% of all poliomyelitis survivors are affected. Patients with PPS may have increased sensitivity to numerous anesthetic agents including neuromuscular blocking drugs. A case report of a patient with PPS undergoing general anesthesia for a cystoscopy procedure is presented. Because of a previous general anesthetic using traditional muscle relaxant reversal of neostigmine, which resulted in prolonged paralysis (6-8 hours) and an intensive care unit admission, sugammadex was used in the cystoscopy procedure. Excellent results were achieved. Following extubation, the patient sustained adequate respiratory effort demonstrated by respiratory rate, end-tidal carbon dioxide, and oxygen saturation within normal limits. Sugammadex administration led to a markedly improved outcome for a patient with a disabling muscle-weakening neurologic disorder. Use of this medication may be of value to other anesthesia providers caring for patients with PPS in an operative setting.