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Sugammadex provides faster reversal of vecuronium-induced neuromuscular blockade compared with neostigmine: a multicenter, randomized, controlled trial.
Anesth Analg. 2010 Jan 01; 110(1):64-73.A&A

Abstract

BACKGROUND

Sugammadex, a specifically designed gamma-cyclodextrin, is a selective relaxant binding drug that rapidly reverses rocuronium-induced and, to a lesser extent, vecuronium-induced neuromuscular blockade. In this study, we compared the efficacy of sugammadex and neostigmine for the reversal of vecuronium-induced neuromuscular blockade in patients scheduled for elective surgery.

METHODS

Patients aged > or = 18 yr, ASA Class I-III, and scheduled for a surgical procedure under sevoflurane/opioid anesthesia received an intubating dose of vecuronium (0.1 mg/kg) and maintenance doses of 0.02-0.03 mg/kg at reappearance of the second twitch (T(2)) of train-of-four (TOF) if required. Neuromuscular blockade was monitored using acceleromyography (TOF-Watch SX, Schering-Plough Ireland, Dublin, Ireland). At end of surgery, at reappearance of T(2) after the last dose of vecuronium, patients were randomized to receive either sugammadex (2 mg/kg) or neostigmine (50 microg/kg) plus glycopyrrolate (10 microg/kg) i.v.. The primary efficacy end-point was time from start of administration of sugammadex or neostigmine to recovery of TOF ratio to 0.9.

RESULTS

The geometric mean time to recovery of the TOF ratio to 0.9 was significantly faster with sugammadex compared with neostigmine (2.7 min [95% confidence interval {CI}]: 2.2-3.3) versus 17.9 min [95% CI: 13.1-24.3], respectively; P < 0.0001). The mean recovery times to a TOF ratio of 0.8 and 0.7 were also significantly shorter with sugammadex. No serious adverse events or unexpected side effects were reported with either drug.

CONCLUSION

Sugammadex provided significantly faster reversal of vecuronium-induced neuromuscular blockade compared with neostigmine.

Authors+Show Affiliations

Medical University Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria. karin.khuenl-brady@i-med.ac.atNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

19713265

Citation

Khuenl-Brady, Karin S., et al. "Sugammadex Provides Faster Reversal of Vecuronium-induced Neuromuscular Blockade Compared With Neostigmine: a Multicenter, Randomized, Controlled Trial." Anesthesia and Analgesia, vol. 110, no. 1, 2010, pp. 64-73.
Khuenl-Brady KS, Wattwil M, Vanacker BF, et al. Sugammadex provides faster reversal of vecuronium-induced neuromuscular blockade compared with neostigmine: a multicenter, randomized, controlled trial. Anesth Analg. 2010;110(1):64-73.
Khuenl-Brady, K. S., Wattwil, M., Vanacker, B. F., Lora-Tamayo, J. I., Rietbergen, H., & Alvarez-Gómez, J. A. (2010). Sugammadex provides faster reversal of vecuronium-induced neuromuscular blockade compared with neostigmine: a multicenter, randomized, controlled trial. Anesthesia and Analgesia, 110(1), 64-73. https://doi.org/10.1213/ane.0b013e3181ac53c3
Khuenl-Brady KS, et al. Sugammadex Provides Faster Reversal of Vecuronium-induced Neuromuscular Blockade Compared With Neostigmine: a Multicenter, Randomized, Controlled Trial. Anesth Analg. 2010 Jan 1;110(1):64-73. PubMed PMID: 19713265.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sugammadex provides faster reversal of vecuronium-induced neuromuscular blockade compared with neostigmine: a multicenter, randomized, controlled trial. AU - Khuenl-Brady,Karin S, AU - Wattwil,Magnus, AU - Vanacker,Bernard F, AU - Lora-Tamayo,José I, AU - Rietbergen,Henk, AU - Alvarez-Gómez,José A, Y1 - 2009/08/27/ PY - 2009/8/29/entrez PY - 2009/8/29/pubmed PY - 2010/1/13/medline SP - 64 EP - 73 JF - Anesthesia and analgesia JO - Anesth Analg VL - 110 IS - 1 N2 - BACKGROUND: Sugammadex, a specifically designed gamma-cyclodextrin, is a selective relaxant binding drug that rapidly reverses rocuronium-induced and, to a lesser extent, vecuronium-induced neuromuscular blockade. In this study, we compared the efficacy of sugammadex and neostigmine for the reversal of vecuronium-induced neuromuscular blockade in patients scheduled for elective surgery. METHODS: Patients aged > or = 18 yr, ASA Class I-III, and scheduled for a surgical procedure under sevoflurane/opioid anesthesia received an intubating dose of vecuronium (0.1 mg/kg) and maintenance doses of 0.02-0.03 mg/kg at reappearance of the second twitch (T(2)) of train-of-four (TOF) if required. Neuromuscular blockade was monitored using acceleromyography (TOF-Watch SX, Schering-Plough Ireland, Dublin, Ireland). At end of surgery, at reappearance of T(2) after the last dose of vecuronium, patients were randomized to receive either sugammadex (2 mg/kg) or neostigmine (50 microg/kg) plus glycopyrrolate (10 microg/kg) i.v.. The primary efficacy end-point was time from start of administration of sugammadex or neostigmine to recovery of TOF ratio to 0.9. RESULTS: The geometric mean time to recovery of the TOF ratio to 0.9 was significantly faster with sugammadex compared with neostigmine (2.7 min [95% confidence interval {CI}]: 2.2-3.3) versus 17.9 min [95% CI: 13.1-24.3], respectively; P < 0.0001). The mean recovery times to a TOF ratio of 0.8 and 0.7 were also significantly shorter with sugammadex. No serious adverse events or unexpected side effects were reported with either drug. CONCLUSION: Sugammadex provided significantly faster reversal of vecuronium-induced neuromuscular blockade compared with neostigmine. SN - 1526-7598 UR - https://www.unboundmedicine.com/medline/citation/19713265/Sugammadex_provides_faster_reversal_of_vecuronium_induced_neuromuscular_blockade_compared_with_neostigmine:_a_multicenter_randomized_controlled_trial_ L2 - https://doi.org/10.1213/ane.0b013e3181ac53c3 DB - PRIME DP - Unbound Medicine ER -