Sugammadex reversal of large subcutaneous injection of rocuronium in an obese patient

In obese patients, correct insertion of the intravenous line and early identification of subcutaneous injection may be difficult.We report management of accidental subcutaneous rocuronium administration in a 38-year-old, obese Korean woman undergoing elective breast cancer surgery.The perioperative management of the patient is discussed, and a review of the literature is provided.Little information is available regarding the absorption of medications outside of the typical route of administration.The accidental subcutaneous infiltration of neuromuscular blocking agents may lead to pulmonary complications.Early identification of subcutaneous infiltration is important and open discussion with many treatment team members is critical.Careful monitoring including neuromuscular monitoring in the post-anesthesia care unit is essential.