Sugammadex rescue in a ‘can intubate but can't ventilate’ scenario

Abstract

We present a case of a 7 year old female who was admitted to hospital with a post tonsillectomy haemorrhage 6 days after an elective day case tonsillectomy for recurrent tonsillitis. Following tracheal intubation the patients lungs' were almost impossible to ventilate due to blood clots within the trachea that could not be removed with suctioning. Reversal of the effects of rocuronium with sugammadex combined with lightening of anaesthesia resulted in a return of spontaneous ventilation and the cough relex, which proved to be life saving for this patient. Two large blood clots were expelled through the tracheal tube, clearing the airway. Flexible bronchoscopy revealed no further distal blood clots or tracheal obstruction. Bleeding from the inferior tonsillar artery was identified and treated. The patient made a full recovery and was discharged home 3 days later.