The Duration of Residual Neuromuscular Block After Administration of Neostigmine or Sugammadex at Two Visible Twitches During Train-of-Four Monitoring

Illman, Hanna; Laurila, Päivi; Antila, Heikki; Meretoja, O. A.; Alahuhta, Seppo; Olkkola, Klaus T.

doi:10.1213/ane.0b013e3181fdf889

Cited by 44 publications

(39 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In conclusion, sugammadex is more rapid and reproducible than neostigmine in restoring neuromuscular function 15 ; however, this property can induce overconfidence in its effectiveness. Therefore, anesthesiologists must follow basic principles for adequate use, specifically, adjust the dose of sugammadex to the level of spontaneous recovery, and assess its efficacy with objective neuromuscular monitoring.…”

Section: Discussionmentioning

confidence: 91%

Recurarization after sugammadex reversal in an obese patient

Corre

Nejmeddine

Fatahine

et al. 2011

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

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

show abstract

Section: Discussionmentioning

confidence: 91%

Recurarization after sugammadex reversal in an obese patient

Corre

Nejmeddine

Fatahine

et al. 2011

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

show abstract

“…Following neostigmine reversal, the time from the appearance of T 2 in TOF count to TOFR 0.9 is much longer, 26 minutes in obese patients compared to 7 minutes in nonobese patients [22] and the "unsafe period of recovery", given as the time from visual loss of fade to TOF 0.9, is 0.3 minutes with sugammadex compared to 10 minutes with neostigmine [23]. Overall, sugammadex appears to be a safer and more predictable reversal agent in obese patients.…”

Section: Use Of Rocuronium and Sugammadex In Morbidly Obese Patientsmentioning

confidence: 98%

Sugammadex: An Update

Ezri

Boaz

Sherman

et al. 2016

The Journal of Critical Care Medicine

View full text Add to dashboard Cite

show abstract

“…The possible benefits and risks of this medication on patients' outcomes have yet to be delineated. [16][17][18][19] …”

Section: Possible Reversal Agentmentioning

confidence: 99%

Residual Neuromuscular Blockade in Critical Care

Wilson

Collins

Rowan

2012

Critical Care Nurse

View full text Add to dashboard Cite

Neuromuscular blockade is a pharmacological adjunct for anesthesia and for surgical interventions. Neuromuscular blockers can facilitate ease of instrumentation and reduce complications associated with intubation. An undesirable sequela of these agents is residual neuromuscular blockade. Residual neuromuscular blockade is linked to aspiration, diminished response to hypoxia, and obstruction of the upper airway that may occur soon after extubation. If an operation is particularly complex or requires a long anesthesia time, residual neuromuscular blockade can contribute to longer stays in the intensive care unit and more hours of mechanical ventilation. Given the risks of this medication class, it is essential to have an understanding of the mechanism of action of, assessment of, and factors affecting blockade and to be able to identify factors that affect pharmacokinetics.

show abstract

The Duration of Residual Neuromuscular Block After Administration of Neostigmine or Sugammadex at Two Visible Twitches During Train-of-Four Monitoring

Abstract: There is a significant time gap between visual loss of fade and return of TOF ratio >0.90 after reversal of a rocuronium block by neostigmine. Sugammadex in comparison with neostigmine allows a safer reversal of a moderate NMB when relying on visual evaluation of the TOF response.

Cited by 44 publications

References 21 publications

Recurarization after sugammadex reversal in an obese patient

Recurarization after sugammadex reversal in an obese patient

Sugammadex: An Update

Residual Neuromuscular Blockade in Critical Care

Contact Info

Product

Resources

About