Reversal of neuromuscular block with sugammadex: a comparison of the corrugator supercilii and adductor pollicis muscles in a randomized dose–response study

Yamamoto, Shiro; Yamamoto, Yusuke; Kitajima, Osamu; Maeda, Takeshi; Suzuki, Takahiro

doi:10.1111/aas.12549

Cited by 21 publications

(22 citation statements)

References 28 publications

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“…In children aged 2 to 5 years, PTC 1 can be detected in 29.8 min even after a high dose of 1 mg•kg −1 of rocuronium. 12) In the light of the fact that the ED 95 of rocuronium in infants is significantly lower than that in older children (0.25 vs. 0.41 mg•kg −1 ), 11) the plasma concentration or number of molecules of rocuronium should be smaller in infants and younger children at the same PTC level. Since one sugammadex molecule encapsulates one rocuronium molecule, it is therefore speculated that a smaller dose of 2 mg•kg −1 of sugammadex may reverse a deep rocuronium-induced neuromuscular block in this study.…”

Section: Discussionmentioning

confidence: 99%

Reversibility of Rocuronium-Induced Deep Neuromuscular Block with Sugammadex in Infants and Children—A Randomized Study

Matsui

Konishi

Suzuki

et al. 2019

Biological & Pharmaceutical Bulletin

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Sugammadex 4 mg•kg 1 is recommended for reversal from rocuronium-induced deep neuromuscular block. However, there is limited data regarding the dose-response of sugammadex required for reversal from deep neuromuscular block in pediatric patients. The aim of this study was to determine the reversibility of rocuronium-induced deep neuromuscular block with sugammadex in infants and children. Seventy-five children (48 infants and 27 children, mean standard deviation (S.D.), age: 11.6 (6.7) months) were enrolled in this study. After induction of anesthesia and administration of 0.6 mg•kg 1 rocuronium, neuromuscular block was acceleromyographically evaluated by observing contractions of the adductor pollicis muscle to ulnar nerve train-of-four (TOF) stimulation. Subsequently, the intensity of rocuronium-induced block was determined every 6 min using post-tetanic count (PTC) stimulation during sevoflurane and remifentanil anesthesia. When the first response to the PTC stimulus was detected, either 1, 2 or 4 mg•kg 1 sugammadex was administered and the time required for facilitated recovery to a TOF ratio of 0.9 following each dose was compared. The time [mean (S.D.)] from the administration of 1 mg•kg 1 sugammadex until recovery to a TOF ratio of 0.9 was significantly longer [129.1 (83.5) s, p < 0.001] than that with 2 and 4 mg•kg 1 sugammadex [70.3 (26.7) s and 68.2 (34.5) s, respectively]. Incomplete reversal was seen in 3 patients in the 1 mg•kg 1 group. The results suggested that a 4 mg•kg 1 sugammadex dose is recommended for reversal from rocuronium-induced deep neuromuscular block even in infants and children.

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Section: Discussionmentioning

confidence: 99%

Reversibility of Rocuronium-Induced Deep Neuromuscular Block with Sugammadex in Infants and Children—A Randomized Study

Matsui

Konishi

Suzuki

et al. 2019

Biological & Pharmaceutical Bulletin

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“…It is notable that this requirement would be equally important if reversal is accomplished with sugammadex, because the current dose recommendations were developed based on the evaluation of the adductor pollicis response and are not applicable when reversal is guided by eye-muscle monitoring. 39 Previous research has demonstrated that administering neostigmine at a TOF count of 4 is significantly more likely to yield satisfactory and timely reversal compared with a lower TOF count. However, it is also clear from previous research that a successful reversal is not guaranteed even when the spontaneous recovery has progressed to a TOF count of 4.…”

Section: Discussionmentioning

confidence: 99%

Management of rocuronium neuromuscular block using a protocol for qualitative monitoring and reversal with neostigmine

Thilen

Cain

et al. 2018

British Journal of Anaesthesia

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“…Some case reports and few clinical studies have evaluated the efficacy and safety of sugammadex in elderly patients 38 – 49 ( Table 3 ). McDonagh et al conducted a parallel-group, comparative, open-label study evaluating sugammadex 2 mg/kg administered for reversal of moderate rocuronium-induced NMB in 150 patients undergoing intravenous or inhalational general anesthesia.…”

Section: Pharmacology In the Elderlymentioning

confidence: 99%

Profile of sugammadex for reversal of neuromuscular blockade in the elderly: current perspectives

Carron

Bertoncello

Ieppariello

2017

CIA

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The number of elderly patients is increasing worldwide. This will have a significant impact on the practice of anesthesia in future decades. Anesthesiologists must provide care for an increasing number of elderly patients, who have an elevated risk of perioperative morbidity and mortality. Complications related to postoperative residual neuromuscular blockade, such as muscle weakness, airway obstruction, hypoxemia, atelectasis, pneumonia, and acute respiratory failure, are more frequent in older than in younger patients. Therefore, neuromuscular blockade in the elderly should be carefully monitored and completely reversed before awakening patients at the end of anesthesia. Acetylcholinesterase inhibitors are traditionally used for reversal of neuromuscular blockade. Although the risk of residual neuromuscular blockade is reduced by reversal with neostigmine, it continues to complicate the postoperative course. Sugammadex represents an innovative approach to reversal of neuromuscular blockade induced by aminosteroid neuromuscular-blocking agents, particularly rocuronium, with useful applications in clinical practice. However, aging is associated with certain changes in the pharmacokinetics of sugammadex, and to date there has been no thorough evaluation of the use of sugammadex in elderly patients. The aim of this review was to perform an analysis of the use of sugammadex in older adults based on the current literature. Major issues surrounding the physiologic and pharmacologic effects of aging in elderly patients and how these may impact the routine use of sugammadex in elderly patients are discussed.

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Reversal of neuromuscular block with sugammadex: a comparison of the corrugator supercilii and adductor pollicis muscles in a randomized dose–response study

Abstract: Sugammadex 4 mg/kg was required to reverse a moderate rocuronium-induced neuromuscular block when the corrugator supercilii muscle is used for monitoring.

Cited by 21 publications

References 28 publications

Reversibility of Rocuronium-Induced Deep Neuromuscular Block with Sugammadex in Infants and Children—A Randomized Study

Reversibility of Rocuronium-Induced Deep Neuromuscular Block with Sugammadex in Infants and Children—A Randomized Study

Management of rocuronium neuromuscular block using a protocol for qualitative monitoring and reversal with neostigmine

Profile of sugammadex for reversal of neuromuscular blockade in the elderly: current perspectives

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