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Reversal of profound neuromuscular block by sugammadex administered three minutes after rocuronium: a comparison with spontaneous recovery from succinylcholine.
Anesthesiology. 2009 May; 110(5):1020-5.A

Abstract

BACKGROUND

Rocuronium in intubation doses provides similar intubation conditions as succinylcholine, but has a longer duration of action. This study compared time to sugammadex reversal of profound rocuronium-induced neuromuscular block with time to spontaneous recovery from succinylcholine.

METHODS

One hundred and fifteen adult American Society of Anesthesiologists Class I-II surgical patients were randomized to this multicenter, safety-assessor-blinded, parallel group, active-controlled, Phase IIIa trial. Anesthesia was induced and maintained with propofol and an opioid. Neuromuscular transmission was blocked and tracheal intubation facilitated with 1.2 mg/kg rocuronium or 1 mg/kg succinylcholine. Sugammadex (16 mg/kg) was administered 3 min after rocuronium administration. Neuromuscular function was monitored by acceleromyography. The primary efficacy endpoint was the time from the start of relaxant administration to recovery of the first train-of-four twitch (T(1)) to 10%.

RESULTS

One hundred and ten patients received study treatment. Mean times to recovery of (T(1)) to 10% and (T(1)) to 90% were significantly faster in the rocuronium-sugammadex group (4.4 and 6.2 min, respectively), as compared with the succinylcholine group (7.1 and 10.9 min, respectively; all P < 0.001). Timed from sugammadex administration, the mean time to recovery of (T(1)) to 10%, (T(1)) to 90%, and the train-of-four (T(4)/T(1)) ratio to 0.9 was 1.2, 2.9, and 2.2 min, respectively. Reoccurrence of the block was not observed. There were no serious adverse events related to study treatments.

CONCLUSION

Reversal of profound high-dose rocuronium-induced neuromuscular block (1.2 mg/kg) with 16 mg/kg sugammadex was significantly faster than spontaneous recovery from 1 mg/kg succinylcholine.

Authors+Show Affiliations

Department of Anesthesiology, David Geffen School of Medicine at University of California Los Angeles, Harbor/UCLA Medical Center, Torrance, CA 90509, USA. chinglee@chinglee.netNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

19387176

Citation

Lee, Chingmuh, et al. "Reversal of Profound Neuromuscular Block By Sugammadex Administered Three Minutes After Rocuronium: a Comparison With Spontaneous Recovery From Succinylcholine." Anesthesiology, vol. 110, no. 5, 2009, pp. 1020-5.
Lee C, Jahr JS, Candiotti KA, et al. Reversal of profound neuromuscular block by sugammadex administered three minutes after rocuronium: a comparison with spontaneous recovery from succinylcholine. Anesthesiology. 2009;110(5):1020-5.
Lee, C., Jahr, J. S., Candiotti, K. A., Warriner, B., Zornow, M. H., & Naguib, M. (2009). Reversal of profound neuromuscular block by sugammadex administered three minutes after rocuronium: a comparison with spontaneous recovery from succinylcholine. Anesthesiology, 110(5), 1020-5. https://doi.org/10.1097/ALN.0b013e31819dabb0
Lee C, et al. Reversal of Profound Neuromuscular Block By Sugammadex Administered Three Minutes After Rocuronium: a Comparison With Spontaneous Recovery From Succinylcholine. Anesthesiology. 2009;110(5):1020-5. PubMed PMID: 19387176.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reversal of profound neuromuscular block by sugammadex administered three minutes after rocuronium: a comparison with spontaneous recovery from succinylcholine. AU - Lee,Chingmuh, AU - Jahr,Jonathan S, AU - Candiotti,Keith A, AU - Warriner,Brian, AU - Zornow,Mark H, AU - Naguib,Mohamed, PY - 2009/4/24/entrez PY - 2009/4/24/pubmed PY - 2009/5/15/medline SP - 1020 EP - 5 JF - Anesthesiology JO - Anesthesiology VL - 110 IS - 5 N2 - BACKGROUND: Rocuronium in intubation doses provides similar intubation conditions as succinylcholine, but has a longer duration of action. This study compared time to sugammadex reversal of profound rocuronium-induced neuromuscular block with time to spontaneous recovery from succinylcholine. METHODS: One hundred and fifteen adult American Society of Anesthesiologists Class I-II surgical patients were randomized to this multicenter, safety-assessor-blinded, parallel group, active-controlled, Phase IIIa trial. Anesthesia was induced and maintained with propofol and an opioid. Neuromuscular transmission was blocked and tracheal intubation facilitated with 1.2 mg/kg rocuronium or 1 mg/kg succinylcholine. Sugammadex (16 mg/kg) was administered 3 min after rocuronium administration. Neuromuscular function was monitored by acceleromyography. The primary efficacy endpoint was the time from the start of relaxant administration to recovery of the first train-of-four twitch (T(1)) to 10%. RESULTS: One hundred and ten patients received study treatment. Mean times to recovery of (T(1)) to 10% and (T(1)) to 90% were significantly faster in the rocuronium-sugammadex group (4.4 and 6.2 min, respectively), as compared with the succinylcholine group (7.1 and 10.9 min, respectively; all P < 0.001). Timed from sugammadex administration, the mean time to recovery of (T(1)) to 10%, (T(1)) to 90%, and the train-of-four (T(4)/T(1)) ratio to 0.9 was 1.2, 2.9, and 2.2 min, respectively. Reoccurrence of the block was not observed. There were no serious adverse events related to study treatments. CONCLUSION: Reversal of profound high-dose rocuronium-induced neuromuscular block (1.2 mg/kg) with 16 mg/kg sugammadex was significantly faster than spontaneous recovery from 1 mg/kg succinylcholine. SN - 1528-1175 UR - https://www.unboundmedicine.com/medline/citation/19387176/Reversal_of_profound_neuromuscular_block_by_sugammadex_administered_three_minutes_after_rocuronium:_a_comparison_with_spontaneous_recovery_from_succinylcholine_ L2 - http://anesthesiology.pubs.asahq.org/article.aspx?doi=10.1097/ALN.0b013e31819dabb0 DB - PRIME DP - Unbound Medicine ER -