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Reversal of neuromuscular blockade with sugammadex at the reappearance of four twitches to train-of-four stimulation.
Anesthesiology. 2013 Jul; 119(1):36-42.A

Abstract

BACKGROUND

Doses of sugammadex required to reverse deep, moderate, and shallow rocuronium-induced neuromuscular blockade have been established. However, no adequate doses for the reversal of reappearance of four twitches of train-of-four (TOF) stimulation (threshold TOF-count-four) have been established.

METHODS

This single-center, randomized, controlled, double-blind, four-groups parallel-arm study included 80 patients undergoing general anesthesia with propofol, sevoflurane, fentanyl, and rocuronium. Neuromuscular monitoring was performed with calibrated acceleromyography. Once rocuronium-induced neuromuscular blockade recovered spontaneously to threshold TOF-count-four, patients randomly received 0.5, 1.0, 2.0 mg/kg of sugammadex or 0.05 mg/kg of neostigmine. The time between study drug injection and reversal of TOF ratios to 1.0 was measured. Rapid reversal (≤2.0 min average, upper limit of 5.0 min) was the primary endpoint and slower reversal (≤5.0 min average, upper limit of 10 min) was the secondary endpoint of the study.

RESULTS

Sugammadex, in doses of 1.0 and 2.0 mg/kg, reversed threshold TOF-count-four to TOF ratios of 1.0 in 2.1±0.8 min (mean±SD) and 1.8±0.9 min, respectively. Sugammadex, 0.5 mg/kg, induced a similar degree of reversal in 4.1±1.9 min (P<0.001 vs. 1.0 and 2.0 mg/kg). Neostigmine, 0.05 mg/kg, reversed TOF ratios to 1.0 in 8.5±3.5 min (P<0.001 vs. sugammadex groups).

CONCLUSION

Sugammadex, 1.0 mg/kg, rapidly and effectively reverses rocuronium-induced block that has recovered spontaneously to a threshold TOF-count-four. A dose of 0.5 mg/kg was equally effective, but satisfactory antagonism took as long as 8 min to take place.

Authors+Show Affiliations

Department of Anesthesiology and Intensive Care, University of Debrecen, Debrecen, Hungary.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

23665915

Citation

Pongrácz, Adrienn, et al. "Reversal of Neuromuscular Blockade With Sugammadex at the Reappearance of Four Twitches to Train-of-four Stimulation." Anesthesiology, vol. 119, no. 1, 2013, pp. 36-42.
Pongrácz A, Szatmári S, Nemes R, et al. Reversal of neuromuscular blockade with sugammadex at the reappearance of four twitches to train-of-four stimulation. Anesthesiology. 2013;119(1):36-42.
Pongrácz, A., Szatmári, S., Nemes, R., Fülesdi, B., & Tassonyi, E. (2013). Reversal of neuromuscular blockade with sugammadex at the reappearance of four twitches to train-of-four stimulation. Anesthesiology, 119(1), 36-42. https://doi.org/10.1097/ALN.0b013e318297ce95
Pongrácz A, et al. Reversal of Neuromuscular Blockade With Sugammadex at the Reappearance of Four Twitches to Train-of-four Stimulation. Anesthesiology. 2013;119(1):36-42. PubMed PMID: 23665915.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reversal of neuromuscular blockade with sugammadex at the reappearance of four twitches to train-of-four stimulation. AU - Pongrácz,Adrienn, AU - Szatmári,Szilárd, AU - Nemes,Réka, AU - Fülesdi,Béla, AU - Tassonyi,Edömér, PY - 2013/5/14/entrez PY - 2013/5/15/pubmed PY - 2013/9/17/medline SP - 36 EP - 42 JF - Anesthesiology JO - Anesthesiology VL - 119 IS - 1 N2 - BACKGROUND: Doses of sugammadex required to reverse deep, moderate, and shallow rocuronium-induced neuromuscular blockade have been established. However, no adequate doses for the reversal of reappearance of four twitches of train-of-four (TOF) stimulation (threshold TOF-count-four) have been established. METHODS: This single-center, randomized, controlled, double-blind, four-groups parallel-arm study included 80 patients undergoing general anesthesia with propofol, sevoflurane, fentanyl, and rocuronium. Neuromuscular monitoring was performed with calibrated acceleromyography. Once rocuronium-induced neuromuscular blockade recovered spontaneously to threshold TOF-count-four, patients randomly received 0.5, 1.0, 2.0 mg/kg of sugammadex or 0.05 mg/kg of neostigmine. The time between study drug injection and reversal of TOF ratios to 1.0 was measured. Rapid reversal (≤2.0 min average, upper limit of 5.0 min) was the primary endpoint and slower reversal (≤5.0 min average, upper limit of 10 min) was the secondary endpoint of the study. RESULTS: Sugammadex, in doses of 1.0 and 2.0 mg/kg, reversed threshold TOF-count-four to TOF ratios of 1.0 in 2.1±0.8 min (mean±SD) and 1.8±0.9 min, respectively. Sugammadex, 0.5 mg/kg, induced a similar degree of reversal in 4.1±1.9 min (P<0.001 vs. 1.0 and 2.0 mg/kg). Neostigmine, 0.05 mg/kg, reversed TOF ratios to 1.0 in 8.5±3.5 min (P<0.001 vs. sugammadex groups). CONCLUSION: Sugammadex, 1.0 mg/kg, rapidly and effectively reverses rocuronium-induced block that has recovered spontaneously to a threshold TOF-count-four. A dose of 0.5 mg/kg was equally effective, but satisfactory antagonism took as long as 8 min to take place. SN - 1528-1175 UR - https://www.unboundmedicine.com/medline/citation/23665915/Reversal_of_neuromuscular_blockade_with_sugammadex_at_the_reappearance_of_four_twitches_to_train_of_four_stimulation_ L2 - https://pubs.asahq.org/anesthesiology/article-lookup/doi/10.1097/ALN.0b013e318297ce95 DB - PRIME DP - Unbound Medicine ER -