Transient Asystole after Sugammadex Administration for Immediate Reversal of Deep Blockade while on Dexmedetomidine Infusion in a Super Obese Patient

Sugammadex is increasingly used to reverse aminosteroid neuromuscular blocking agents. Dosing is calculated based on actual body weight, even for those who are obese. We report a case where a super obese patient (BMI 58.5 kg/m2) developed asystole, following coadministration with dexmedetomidine, for rapid reversal after deep blockade. Although 16mg/kg of actual body weight is recommended for prompt reversal of deep blockade, dosing adjustments may be prudent in the obese population, especially when used in conjunction with other negative chronotropic agents.