Neuromuscular blocking drug extravasation – Full Text

"This case highlights the unpredictable clinical course of NMBD extravasation and demonstrates that recurrent paralysis may occur despite initial successful reversal, requiring quantitative neuromuscular monitoring, extended postoperative observation, and administration of repeat doses of sugammadex as delayed systemic absorption occurs" Crafton et al (2026).

"This case highlights the unpredictable clinical course of NMBD extravasation and demonstrates that recurrent paralysis may occur despite initial successful reversal, requiring quantitative neuromuscular monitoring, extended postoperative observation, and administration of repeat doses of sugammadex as delayed systemic absorption occurs" Crafton et al (2026).

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Neuromuscular blocking drug extravasation

Abstract:

Extravascular infiltration of neuromuscular blocking drugs (NMBDs) is a perioperative complication that may result in delayed and recurrent paralysis due to gradual systemic absorption from subcutaneous tissue. We report the case of a 64-year-old female who experienced inadvertent peripheral intravenous infiltration (PIV) during intraoperative administration of vecuronium and rocuronium. Following routine reversal with sugammadex, she developed recurrent episodes of respiratory compromise and profound weakness in the post-anesthesia care unit, consistent with delayed absorption of the extravasated NMBD. Each episode resolved promptly after repeat intravenous administration of sugammadex. This case highlights the unpredictable clinical course of NMBD extravasation and demonstrates that recurrent paralysis may occur despite initial successful reversal, requiring quantitative neuromuscular monitoring, extended postoperative observation, and administration of repeat doses of sugammadex as delayed systemic absorption occurs.

Reference:

Crafton W, Orlov M, Southerland W. Management of Neuromuscular Blocking Drug Extravasation With Sugammadex: A Case Report. Cureus. 2026 Sep 2;18(9):e115645. doi: 10.7759/cureus.115645. PMID: 42827945; PMCID: PMC13632570.