Sugammadex and Acceleromyography Used During a Lensectomy in a Sea Lion

Neuromuscular blocking agents (NMBAs) are essential in intraocular surgeries to improve surgical conditions and ensure optimal ventilation. However, residual blockade can pose significant risks, particularly in pinnipeds due to their unique diving physiology. This case report examines the use of sugammadex for reversing the effect of rocuronium and the application of acceleromyography (AMG) for monitoring of neuromuscular block (NMB) in a California sea lion undergoing lensectomy. Rocuronium (0.3 mg/kg IV) was used to achieve complete NMB, and an additional 0.1 mg/kg to prolong the block. Sugammadex (1 mg/kg IV) effectively reversed the NMB within 90 seconds. Neuromuscular function was monitored using AMG, with the ulnar nerve in the front flipper serving as the stimulation site. The AMG allowed for objective monitoring of neuromuscular blockade, ensuring accurate titration of the NMBA and its reversal agent. This case represents the first report describing the use of sugammadex in a sea lion for reversing the effect of rocuronium and the use of AMG for monitoring of NMB, demonstrating its potential for improving anaesthesia protocols and patient safety in marine mammal anaesthesia.