Sugammadex Provides Faster Reversal of Vecuronium-Induced Neuromuscular Blockade Compared with Neostigmine: A Multicenter, Randomized, Controlled Trial

Khuenl-Brady, Karin S.; Wattwil, Magnus; Vanacker, Bernard; Lora-Tamayo, José I.; Rietbergen, Henk; Álvarez‐Gómez, José A.

doi:10.1213/ane.0b013e3181ac53c3

Cited by 154 publications

(117 citation statements)

References 25 publications

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“…The times to the restoration of complete conduction following deep block induced with rocuronium or vecuronium are dose-dependent [23]. Sugammadex at 2 mg kg -1 restored complete conduction following vecuronium-induced block within 2.7 minutes, whereas neostigmine at a dose of 50 µg kg -1 requires 17.9 minutes [24]. The discrepancies with our observations likely resulted from the use of different methods of anaesthesia and procedures.…”

Section: Discussioncontrasting

confidence: 79%

Zastosowanie sugammadeksu do odwracania bloku nerwowo-mięśniowego wywołanego wekuronium po operacjach wewnątrzczaszkowych

Karwacki¹,

Niewiadomski²,

Rzaska³

2015

Anaesthesiol Intensive Ther

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Background: Total intravenous anaesthesia with propofol and remifentanil is widely used in neuroanaesthesiology and enables the quick recovery and early neurological assessment of patients. The administration of muscle relaxants carries a risk of residual relaxation following surgery. The administration of a suitable dose of sugammadex reverses the neuromuscular block irrespective of its depth and has none of the side effects associated with acetylcholinesterase inhibitors. The aim of the present study was to evaluate the usefulness of sugammadex for the reversal of vecuroniuminduced effects following intracranial surgery. Method: The study involved 38 women who underwent supratentorial tumour removal. These women were randomly divided into two groups. Total intravenous anaesthesia with propofol and remifentanil using target-controlled infusion was administered according to the Schnider and Minto models, respectively. Endotracheal intubation was performed after the target concentrations of propofol and remifentanil reached 4 µg mL -1 and 4 ng mL -1 , respectively. Vecuronium (100 µg kg -1 ) was administered, and no response to TOF stimulation was observed. Relaxation was continued via the continuous infusion of vecuronium (0.8-1.2 µg kg -1 min -1 ) to provide a TOF of 2 throughout the surgery. In group I, neuromuscular conduction was restored with intravenous sugammadex (2 mg kg -1 ), whereas in group II, no reversal agents were administered. Results: The times of the return of spontaneous breathing, extubation, eye opening (both spontaneous and in response to a verbal command) were found to be longer in group II than group I. Conclusion: The use of sugammadex following craniotomy accelerates the achievement of optimal extubation conditions.

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Section: Discussioncontrasting

confidence: 79%

Zastosowanie sugammadeksu do odwracania bloku nerwowo-mięśniowego wywołanego wekuronium po operacjach wewnątrzczaszkowych

Karwacki¹,

Niewiadomski²,

Rzaska³

2015

Anaesthesiol Intensive Ther

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“…All efficacy analyses were performed using intent-to-treat, comprising all randomised patients who received sugammadex or neostigmine and had at least one efficacy measurement. Missing times to recovery of the TOF ratio to 0.9 were imputed for the primary analysis, consistent with previous sugammadex studies [3,5]. A supportive analysis was performed using patients with available recovery times only.…”

Section: Methodsmentioning

confidence: 99%

“…In contrast to neostigmine, sugammadex (Bridion Ò , Merck Sharp and Dohme (MSD), Oss, the Netherlands) has the potential to achieve reliable, complete and rapid reversal of both moderate and deep rocuronium-and vecuronium-induced neuromuscular blockade [3][4][5][6].…”

mentioning

confidence: 99%

A randomised controlled trial comparing sugammadex and neostigmine at different depths of neuromuscular blockade in patients undergoing laparoscopic surgery*

et al. 2012

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SummaryDeep neuromuscular blockade during certain surgical procedures may improve operating conditions. Sugammadex can be used to reverse deep neuromuscular blockade without waiting for spontaneous recovery. This randomised study compared recovery times from neuromuscular blockade induced by rocuronium 0.6 mg.kg , using sugammadex 4 mg.kg )1 administered at 1-2 post-tetanic count (deep blockade) or neostigmine 50 lg.kg )1 (plus atropine 10 lg.kg )1 ) administered at the re-appearance of the second twitch of a train-of-four stimulation (moderate blockade), in patients undergoing laparoscopic surgery. The primary efficacy variable was the time from the start of sugammadex ⁄ neostigmine administration to recovery of the train-of-four ratio to 0.9. Patients receiving sugammadex recovered 3.4 times faster than patients receiving neostigmine (geometric mean (95% CI) recovery times of 2.4 (2.1-2.7) and 8.4 (7.2-9.8) min, respectively, p < 0.0001). Moreover, 94% (62 ⁄ 66) of sugammadex-treated patients recovered within 5 min, vs 20% (13 ⁄ 65) of neostigmine-treated patients, despite the difference in the depth of neuromuscular blockade at the time of administration of both drugs. The ability to provide deep neuromuscular blockade throughout the procedure but still permit reversal at the end of surgery may enable improved surgical access and an enhanced visual field.

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“…This is also the level of neuromuscular blockade at which reversal with acetylcholinesterase inhibitors is possible. 1 After sugammadex 2 mgÁkg -1 iv, the median time to obtain a TOF ratio (TOFR) C 0.9 was reported as 1.4(0.9-5.4) min and 2.1(1.6-64.2) min for rocuronium 2 and vecuronium, 3 respectively. After neostigmine 50 lgÁkg -1 iv, this delay was reported as 18.5(3.7-106.9) min and 21.9(2.9-76.2) min for rocuronium 2 and vecuronium, 3 respectively.…”

Section: Résumémentioning

confidence: 99%

Recurarization after sugammadex reversal in an obese patient

Corre

Nejmeddine

Fatahine

et al. 2011

Can J Anesth/J Can Anesth

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Purpose We report a case that involved immediate postoperative respiratory failure necessitating tracheal intubation, which was possibly related to recurarization after sugammadex reversal. Clinical findings A 54-yr-old woman weighing 115-kg was scheduled for laparoscopic repair of abdominal dehiscence under general anesthesia. Muscle relaxation was induced and maintained with rocuronium (170 mg iv total dose). At the end of the 170-min procedure, two twitches were visualized after supramaximal train-of-four (TOF) stimulation at the adductor pollicis muscle, and the patient's central core temperature was 35.6°C. Sugammadex 200 mg iv (1.74 mgÁkg -1 ) was administered. With the patient fully awake, a TOF ratio 0.9 was obtained five minutes later. The tracheal tube was then removed, and the patient was transferred to the postanesthesia care unit. Ten minutes later, the patient presented respiratory failure necessitating tracheal intubation and sedation with propofol. One TOF response only was visualized at the adductor pollicis muscle. Another dose of sugammadex 200 mg iv was administered. Forty-five minutes later, the patient was fully awake and her trachea was extubated after repeated measures of the TOF ratio (C 0.9) at the adductor pollicis muscle. The patient fully recovered without sequelae, further complication, or prolonged hospital stay. Conclusion Shortly after tracheal extubation, an obese patient experienced respiratory failure necessitating tracheal intubation and an additional dose of sugammadex. This occurred despite initial reversal of neuromuscular blockade with an appropriate dose of sugammadex 2 mgÁkg -1 iv given at two responses to TOF stimulation. RésuméObjectif Nous de´crivons un cas de de´tresse respiratoire survenu en postope´ratoire imme´diat ne´cessitant l'intubation de la trache´e, possiblement lie´a`une recurarisation apre`s une de´curarisation pharmacologique avec du sugammadex. É léments cliniques Une femme de 54 ans, pesant 115 kg, e´tait programme´e pour le traitement chirurgical d'une e´ventration de la paroi abdominale par laparoscopie sous anesthe´sie ge´ne´rale. La curarisation e´tait induite et entretenue par du rocuronium (dose totale 170 mg iv). A`la fin de l'intervention, durant 170 min, deux re´ponses e´taient visualise´es apre`s une stimulation supra-maximale par un train-de-quatre (Td4) a`l'adducteur du pouce, et la tempe´rature centrale e´tait de 35,6°C. Une dose de 200 mg iv de sugammadex (1,74 mgÁkg -1 ) a e´te´administre´e pour la de´curarisation pharmacologique. Un rapport de Td4 a`0,9 al 'adducteur du pouce e´tait obtenu cinq minutes plus tard permettant le retrait de la sonde d'intubation et le transfert en salle de re´veil, la patiente re´pondant aux ordres simples. Dix minutes plus tard, elle pre´sentait une de´tresse respiratoire ne´cessitant l'intubation de la trache´e et une se´dation au propofol. Une seule re´ponse e´tait visualise´e au Td4 a`l'adducteur du pouce. Une dose supple´mentaire de 200 mg iv de sugammadex a e´te´administre´e. Quarante-cinq

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Sugammadex Provides Faster Reversal of Vecuronium-Induced Neuromuscular Blockade Compared with Neostigmine: A Multicenter, Randomized, Controlled Trial

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

Cited by 154 publications

References 25 publications

Zastosowanie sugammadeksu do odwracania bloku nerwowo-mięśniowego wywołanego wekuronium po operacjach wewnątrzczaszkowych

Zastosowanie sugammadeksu do odwracania bloku nerwowo-mięśniowego wywołanego wekuronium po operacjach wewnątrzczaszkowych

A randomised controlled trial comparing sugammadex and neostigmine at different depths of neuromuscular blockade in patients undergoing laparoscopic surgery*

Recurarization after sugammadex reversal in an obese patient

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