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This is a case of a 62-year-old female with amyotrophic lateral sclerosis (ALS) and bulbar involvement. The patient was scheduled for percutaneous endoscopic gastrostomy under general anesthesia. The TOF stimulation was used to monitor neuromuscular blockade from the beginning of the induction until extubating process. General anesthesia was induced by intravenous administration of propofol and was intubated with rocuronium. General anesthesia was maintained by sevoflurane. Pain control with local infiltration of 0.5% bupivacaine at the surgical site without an intravenous opioid. The patient emerged from general anesthesia smoothly and was extubated after an administration of sugammadex without any complications. This case report showed that rocuronium and sugammadex could be used safely in these patients; however, neuromuscular monitoring and clinical correlation should be performed to determine the muscle power to ensure the extubating process, and further research is needed to determine the appropriate dose of rocuronium and sugammadex for ALS patients.
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