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Reversal of rocuronium-induced neuromuscular block with sugammadex is faster than reversal of cisatracurium-induced block with neostigmine.
Br J Anaesth. 2008 May; 100(5):622-30.BJ

Abstract

BACKGROUND

Reversal of the residual effect of rocuronium or cisatracurium by neostigmine may be slow and associated with side-effects. This randomized, safety-assessor-blinded study compared the efficacy of sugammadex, a selective relaxant binding agent for reversal of rocuronium-induced neuromuscular block, with that of neostigmine for reversal of cisatracurium-induced neuromuscular block. The safety of sugammadex and neostigmine was also evaluated.

METHODS

Adult surgical patients (ASA class I-III) were randomized to sugammadex 2.0 mg kg(-1) for reversal of block induced by rocuronium 0.6 mg kg(-1), or neostigmine 50 microg kg(-1) for reversal of block induced by cisatracurium 0.15 mg kg(-1). Anaesthesia was induced and maintained using i.v. propofol and remifentanil, fentanyl, or sufentanil. Neuromuscular function was monitored using acceleromyography (TOF-Watch SX). Sugammadex or neostigmine was administered at reappearance of T(2). The primary efficacy variable was time for recovery of the train-of-four (TOF) ratio to 0.9.

RESULTS

Eighty-four patients were randomized, 73 of whom received sugammadex (n=34) or neostigmine (n=39). Time from start of administration of reversal agent to recovery of the TOF ratio to 0.9 was 4.7 times faster with sugammadex than with neostigmine (geometric mean=1.9 vs 9.0 min, P<0.0001). Reversal of block was sustained in all patients. There were no serious adverse effects from either reversal agent and no significant changes in any measure of safety, except for similar elevations in urinary N-acetyl glucosaminidase in both groups.

CONCLUSIONS

Sugammadex 2.0 mg kg(-1) administered at reappearance of T(2) was significantly faster in reversing rocuronium-induced blockade than neostigmine was in reversing cisatracurium-induced block.

Authors+Show Affiliations

University Department of Anaesthesia, School of Clinical Sciences, Duncan Building, Daulby Street, Liverpool L69 3GA, UK. lizzy@lizzyflockton.fsnet.co.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial, Phase III
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18385265

Citation

Flockton, E A., et al. "Reversal of Rocuronium-induced Neuromuscular Block With Sugammadex Is Faster Than Reversal of Cisatracurium-induced Block With Neostigmine." British Journal of Anaesthesia, vol. 100, no. 5, 2008, pp. 622-30.
Flockton EA, Mastronardi P, Hunter JM, et al. Reversal of rocuronium-induced neuromuscular block with sugammadex is faster than reversal of cisatracurium-induced block with neostigmine. Br J Anaesth. 2008;100(5):622-30.
Flockton, E. A., Mastronardi, P., Hunter, J. M., Gomar, C., Mirakhur, R. K., Aguilera, L., Giunta, F. G., Meistelman, C., & Prins, M. E. (2008). Reversal of rocuronium-induced neuromuscular block with sugammadex is faster than reversal of cisatracurium-induced block with neostigmine. British Journal of Anaesthesia, 100(5), 622-30. https://doi.org/10.1093/bja/aen037
Flockton EA, et al. Reversal of Rocuronium-induced Neuromuscular Block With Sugammadex Is Faster Than Reversal of Cisatracurium-induced Block With Neostigmine. Br J Anaesth. 2008;100(5):622-30. PubMed PMID: 18385265.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reversal of rocuronium-induced neuromuscular block with sugammadex is faster than reversal of cisatracurium-induced block with neostigmine. AU - Flockton,E A, AU - Mastronardi,P, AU - Hunter,J M, AU - Gomar,C, AU - Mirakhur,R K, AU - Aguilera,L, AU - Giunta,F G, AU - Meistelman,C, AU - Prins,M E, Y1 - 2008/04/02/ PY - 2008/4/4/pubmed PY - 2008/5/14/medline PY - 2008/4/4/entrez SP - 622 EP - 30 JF - British journal of anaesthesia JO - Br J Anaesth VL - 100 IS - 5 N2 - BACKGROUND: Reversal of the residual effect of rocuronium or cisatracurium by neostigmine may be slow and associated with side-effects. This randomized, safety-assessor-blinded study compared the efficacy of sugammadex, a selective relaxant binding agent for reversal of rocuronium-induced neuromuscular block, with that of neostigmine for reversal of cisatracurium-induced neuromuscular block. The safety of sugammadex and neostigmine was also evaluated. METHODS: Adult surgical patients (ASA class I-III) were randomized to sugammadex 2.0 mg kg(-1) for reversal of block induced by rocuronium 0.6 mg kg(-1), or neostigmine 50 microg kg(-1) for reversal of block induced by cisatracurium 0.15 mg kg(-1). Anaesthesia was induced and maintained using i.v. propofol and remifentanil, fentanyl, or sufentanil. Neuromuscular function was monitored using acceleromyography (TOF-Watch SX). Sugammadex or neostigmine was administered at reappearance of T(2). The primary efficacy variable was time for recovery of the train-of-four (TOF) ratio to 0.9. RESULTS: Eighty-four patients were randomized, 73 of whom received sugammadex (n=34) or neostigmine (n=39). Time from start of administration of reversal agent to recovery of the TOF ratio to 0.9 was 4.7 times faster with sugammadex than with neostigmine (geometric mean=1.9 vs 9.0 min, P<0.0001). Reversal of block was sustained in all patients. There were no serious adverse effects from either reversal agent and no significant changes in any measure of safety, except for similar elevations in urinary N-acetyl glucosaminidase in both groups. CONCLUSIONS: Sugammadex 2.0 mg kg(-1) administered at reappearance of T(2) was significantly faster in reversing rocuronium-induced blockade than neostigmine was in reversing cisatracurium-induced block. SN - 1471-6771 UR - https://www.unboundmedicine.com/medline/citation/18385265/Reversal_of_rocuronium_induced_neuromuscular_block_with_sugammadex_is_faster_than_reversal_of_cisatracurium_induced_block_with_neostigmine_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0007-0912(17)34328-3 DB - PRIME DP - Unbound Medicine ER -