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The effect of residual neuromuscular blockade on the speed of reversal with sugammadex.
Anesth Analg. 2009 Mar; 108(3):846-51.A&A

Abstract

BACKGROUND

Sugammadex is a modified gamma cyclodextrin compound which encapsulates rocuronium resulting in rapid reversal of residual neuromuscular blockade. We performed a post hoc analysis of data from a multicenter study designed to mimic standard clinical practice which would test the hypothesis that the presence (versus the absence) of a twitch response to neuromuscular stimulation at the time of reversal drug administration would influence the speed and completeness of the reversal effect of sugammadex.

METHODS

One-hundred-seventy-one consenting patients undergoing general anesthesia with a volatile-based anesthetic technique were enrolled in a multicenter observational study. All patients received rocuronium, 0.6 mg/kg i.v. for tracheal intubation and maintenance boluses of 0.15 mg/kg i.v. as needed during surgery. The degree of rocuronium-induced blockade was assessed during anesthesia using a TOF-Watch-SX acceleromyograph to record the train-of-four (TOF) responses on a laptop computer from induction of anesthesia until the TOF ratio returned to > or = 0.9 after completion of the surgical procedure. The patients received sugammadex, 4 mg/kg i.v., for reversal of neuromuscular blockade > 15 min after the last dose of rocuronium. Recovery data were compared in patients with either no (0) (n = 89) or > or = 1 twitch (n = 82) in response to TOF stimulation at the time of reversal drug administration.

RESULTS

The patients without a twitch response were more likely to be female (60% vs 40%) and had a shorter time interval between the last bolus dose of rocuronium and the administration of the reversal drug (31+/-18 vs 45+/-23 min, P < 0.05). The time to achieve a TOF ratio of 0.9 was prolonged in the 0 twitch group compared with the > or = 1 twitch response group (173+/-162 vs 104+/-73 s, P < 0.05). Overall, 84% of the patients in the 0 twitch group recovered to a TOF of 0.9 in < or = 5 min compared to 91% of the patients in the group with > or = 1 twitch (P < 0.05). The times to achieve a TOF of 0.9 varied from 0.8 to 22.3 and 0.7 to 8.5 min in the 0 twitch and > or = 1 twitch groups, respectively.

CONCLUSION

Reversal of rocuronium-induced neuromuscular blockade by sugammadex was influenced by the degree of residual blockade at the time the reversal drug was administered. Despite the wide variability, reversal of the TOF ratio to 0.9 occurred < or = 5 min in more than 80% of the patients regardless of the number of twitches at the time of reversal drug administration.

Authors+Show Affiliations

Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, 5161 Harry Hines Boulevard, CS 2. 282, Dallas, TX 75390-9068, USA. paul.white@utsouthwestern.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

19224792

Citation

White, Paul F., et al. "The Effect of Residual Neuromuscular Blockade On the Speed of Reversal With Sugammadex." Anesthesia and Analgesia, vol. 108, no. 3, 2009, pp. 846-51.
White PF, Tufanogullari B, Sacan O, et al. The effect of residual neuromuscular blockade on the speed of reversal with sugammadex. Anesth Analg. 2009;108(3):846-51.
White, P. F., Tufanogullari, B., Sacan, O., Pavlin, E. G., Viegas, O. J., Minkowitz, H. S., & Hudson, M. E. (2009). The effect of residual neuromuscular blockade on the speed of reversal with sugammadex. Anesthesia and Analgesia, 108(3), 846-51. https://doi.org/10.1213/ane.0b013e31818a9932
White PF, et al. The Effect of Residual Neuromuscular Blockade On the Speed of Reversal With Sugammadex. Anesth Analg. 2009;108(3):846-51. PubMed PMID: 19224792.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The effect of residual neuromuscular blockade on the speed of reversal with sugammadex. AU - White,Paul F, AU - Tufanogullari,Burcu, AU - Sacan,Ozlem, AU - Pavlin,Edward G, AU - Viegas,Oscar J, AU - Minkowitz,Harold S, AU - Hudson,M E, PY - 2009/2/20/entrez PY - 2009/2/20/pubmed PY - 2009/3/13/medline SP - 846 EP - 51 JF - Anesthesia and analgesia JO - Anesth. Analg. VL - 108 IS - 3 N2 - BACKGROUND: Sugammadex is a modified gamma cyclodextrin compound which encapsulates rocuronium resulting in rapid reversal of residual neuromuscular blockade. We performed a post hoc analysis of data from a multicenter study designed to mimic standard clinical practice which would test the hypothesis that the presence (versus the absence) of a twitch response to neuromuscular stimulation at the time of reversal drug administration would influence the speed and completeness of the reversal effect of sugammadex. METHODS: One-hundred-seventy-one consenting patients undergoing general anesthesia with a volatile-based anesthetic technique were enrolled in a multicenter observational study. All patients received rocuronium, 0.6 mg/kg i.v. for tracheal intubation and maintenance boluses of 0.15 mg/kg i.v. as needed during surgery. The degree of rocuronium-induced blockade was assessed during anesthesia using a TOF-Watch-SX acceleromyograph to record the train-of-four (TOF) responses on a laptop computer from induction of anesthesia until the TOF ratio returned to > or = 0.9 after completion of the surgical procedure. The patients received sugammadex, 4 mg/kg i.v., for reversal of neuromuscular blockade > 15 min after the last dose of rocuronium. Recovery data were compared in patients with either no (0) (n = 89) or > or = 1 twitch (n = 82) in response to TOF stimulation at the time of reversal drug administration. RESULTS: The patients without a twitch response were more likely to be female (60% vs 40%) and had a shorter time interval between the last bolus dose of rocuronium and the administration of the reversal drug (31+/-18 vs 45+/-23 min, P < 0.05). The time to achieve a TOF ratio of 0.9 was prolonged in the 0 twitch group compared with the > or = 1 twitch response group (173+/-162 vs 104+/-73 s, P < 0.05). Overall, 84% of the patients in the 0 twitch group recovered to a TOF of 0.9 in < or = 5 min compared to 91% of the patients in the group with > or = 1 twitch (P < 0.05). The times to achieve a TOF of 0.9 varied from 0.8 to 22.3 and 0.7 to 8.5 min in the 0 twitch and > or = 1 twitch groups, respectively. CONCLUSION: Reversal of rocuronium-induced neuromuscular blockade by sugammadex was influenced by the degree of residual blockade at the time the reversal drug was administered. Despite the wide variability, reversal of the TOF ratio to 0.9 occurred < or = 5 min in more than 80% of the patients regardless of the number of twitches at the time of reversal drug administration. SN - 1526-7598 UR - https://www.unboundmedicine.com/medline/citation/19224792/The_effect_of_residual_neuromuscular_blockade_on_the_speed_of_reversal_with_sugammadex_ L2 - http://dx.doi.org/10.1213/ane.0b013e31818a9932 DB - PRIME DP - Unbound Medicine ER -