Tags

Type your tag names separated by a space and hit enter

Effects of sugammadex on incidence of postoperative residual neuromuscular blockade: a randomized, controlled study.
Br J Anaesth. 2015 Nov; 115(5):743-51.BJ

Abstract

BACKGROUND

This study aimed to investigate whether reversal of rocuronium-induced neuromuscular blockade with sugammadex reduced the incidence of residual blockade and facilitated operating room discharge readiness.

METHODS

Adult patients undergoing abdominal surgery received rocuronium, followed by randomized allocation to sugammadex (2 or 4 mg kg(-1)) or usual care (neostigmine/glycopyrrolate, dosing per usual care practice) for reversal of neuromuscular blockade. Timing of reversal agent administration was based on the providers' clinical judgement. Primary endpoint was the presence of residual neuromuscular blockade at PACU admission, defined as a train-of-four (TOF) ratio <0.9, using TOF-Watch® SX. Key secondary endpoint was time between reversal agent administration and operating room discharge-readiness; analysed with analysis of covariance.

RESULTS

Of 154 patients randomized, 150 had a TOF value measured at PACU entry. Zero out of 74 sugammadex patients and 33 out of 76 (43.4%) usual care patients had TOF-Watch SX-assessed residual neuromuscular blockade at PACU admission (odds ratio 0.0, 95% CI [0-0.06], P<0.0001). Of these 33 usual care patients, 2 also had clinical evidence of partial paralysis. Time between reversal agent administration and operating room discharge-readiness was shorter for sugammadex vs usual care (14.7 vs. 18.6 min respectively; P=0.02).

CONCLUSIONS

After abdominal surgery, sugammadex reversal eliminated residual neuromuscular blockade in the PACU, and shortened the time from start of study medication administration to the time the patient was ready for discharge from the operating room.

CLINICAL TRIAL REGISTRATION

Clinicaltrials.gov:NCT01479764.

Authors+Show Affiliations

Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA02114, USA.Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA02114, USA.Biostatistics and Research Decision Sciences, MSD, Oss, The Netherlands.Clinical Research, Merck Sharp & Dohme Corp, Whitehouse Station, NJ, USA.Clinical Research, Merck Sharp & Dohme Corp, Whitehouse Station, NJ, USA.Clinical Research, Merck Sharp & Dohme Corp, Whitehouse Station, NJ, USA.Trauma, Emergency Surgery, Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.Trauma, Emergency Surgery, Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA02114, USA Harvard Medical School, Boston, MA, USA.Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA02114, USA Harvard Medical School, Boston, MA, USA.Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA02114, USA.Harvard Medical School, Boston, MA, USA Department of Urology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA02114, USA Department of Anesthesiology, Herlev Hospital, University of Copenhagen, Herlev, Denmark.Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA02114, USA Harvard Medical School, Boston, MA, USA Essen-Duisburg University, Essen, Germany meikermann@partners.org.

Pub Type(s)

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

Language

eng

PubMed ID

25935840

Citation

Brueckmann, B, et al. "Effects of Sugammadex On Incidence of Postoperative Residual Neuromuscular Blockade: a Randomized, Controlled Study." British Journal of Anaesthesia, vol. 115, no. 5, 2015, pp. 743-51.
Brueckmann B, Sasaki N, Grobara P, et al. Effects of sugammadex on incidence of postoperative residual neuromuscular blockade: a randomized, controlled study. Br J Anaesth. 2015;115(5):743-51.
Brueckmann, B., Sasaki, N., Grobara, P., Li, M. K., Woo, T., de Bie, J., Maktabi, M., Lee, J., Kwo, J., Pino, R., Sabouri, A. S., McGovern, F., Staehr-Rye, A. K., & Eikermann, M. (2015). Effects of sugammadex on incidence of postoperative residual neuromuscular blockade: a randomized, controlled study. British Journal of Anaesthesia, 115(5), 743-51. https://doi.org/10.1093/bja/aev104
Brueckmann B, et al. Effects of Sugammadex On Incidence of Postoperative Residual Neuromuscular Blockade: a Randomized, Controlled Study. Br J Anaesth. 2015;115(5):743-51. PubMed PMID: 25935840.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of sugammadex on incidence of postoperative residual neuromuscular blockade: a randomized, controlled study. AU - Brueckmann,B, AU - Sasaki,N, AU - Grobara,P, AU - Li,M K, AU - Woo,T, AU - de Bie,J, AU - Maktabi,M, AU - Lee,J, AU - Kwo,J, AU - Pino,R, AU - Sabouri,A S, AU - McGovern,F, AU - Staehr-Rye,A K, AU - Eikermann,M, Y1 - 2015/05/02/ PY - 2015/02/11/accepted PY - 2015/5/4/entrez PY - 2015/5/4/pubmed PY - 2016/1/26/medline KW - neostigmine/glycopyrrolate KW - neuromuscular blockade KW - neuromuscular blocking agents KW - randomized-controlled trial KW - rocuronium KW - sugammadex SP - 743 EP - 51 JF - British journal of anaesthesia JO - Br J Anaesth VL - 115 IS - 5 N2 - BACKGROUND: This study aimed to investigate whether reversal of rocuronium-induced neuromuscular blockade with sugammadex reduced the incidence of residual blockade and facilitated operating room discharge readiness. METHODS: Adult patients undergoing abdominal surgery received rocuronium, followed by randomized allocation to sugammadex (2 or 4 mg kg(-1)) or usual care (neostigmine/glycopyrrolate, dosing per usual care practice) for reversal of neuromuscular blockade. Timing of reversal agent administration was based on the providers' clinical judgement. Primary endpoint was the presence of residual neuromuscular blockade at PACU admission, defined as a train-of-four (TOF) ratio <0.9, using TOF-Watch® SX. Key secondary endpoint was time between reversal agent administration and operating room discharge-readiness; analysed with analysis of covariance. RESULTS: Of 154 patients randomized, 150 had a TOF value measured at PACU entry. Zero out of 74 sugammadex patients and 33 out of 76 (43.4%) usual care patients had TOF-Watch SX-assessed residual neuromuscular blockade at PACU admission (odds ratio 0.0, 95% CI [0-0.06], P<0.0001). Of these 33 usual care patients, 2 also had clinical evidence of partial paralysis. Time between reversal agent administration and operating room discharge-readiness was shorter for sugammadex vs usual care (14.7 vs. 18.6 min respectively; P=0.02). CONCLUSIONS: After abdominal surgery, sugammadex reversal eliminated residual neuromuscular blockade in the PACU, and shortened the time from start of study medication administration to the time the patient was ready for discharge from the operating room. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov:NCT01479764. SN - 1471-6771 UR - https://www.unboundmedicine.com/medline/citation/25935840/Effects_of_sugammadex_on_incidence_of_postoperative_residual_neuromuscular_blockade:_a_randomized_controlled_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0007-0912(17)31076-0 DB - PRIME DP - Unbound Medicine ER -