The Usefulness of Rocuronium and Sugammadex in the Anesthetic and Surgical Management of an Infant with Large Mediastinal Mass: A Case Report

Pediatric patients with large mediastinal mass are in danger of having critical respiratory and hemodynamic problems during anesthetic and surgical process. Traditionally, the key to the success of anesthetic management in pediatric patients with mediastinal mass is to keep spontaneous respiration without administration of muscle relaxants during the whole anesthetic period. Nevertheless, spontaneous respiration may interfere with fine important surgical procedures compared to mechanical ventilation. We hypothesized that a new anesthetic strategy using rocuronium and sugammadex might facilitate mechanical ventilation and surgical procedures, and provide complete and fast recovery of neuromuscular and respiratory function without respiratory complication. Here, we present an infant with severely compressed airway due to large mediastinal mass successfully managed with a special anesthetic strategy including use of rocuronium and sugammadex for effective and safe neuromuscular blockade and recovery, and supportive use of a fiberoptic bronchoscope for securing the airway.