Reversal of Profound Neuromuscular Block by Sugammadex Administered Three Minutes after Rocuronium

Author:

Lee Chingmuh1,Jahr Jonathan S.2,Candiotti Keith A.3,Warriner Brian4,Zornow Mark H.5,Naguib Mohamed6

Affiliation:

1. Professor Emeritus, Department of Anesthesiology, David Geffen School of Medicine at the University of California Los Angeles, Harbor/UCLA Medical Center, Torrance, California.

2. Professor of Clinical Anesthesiology, David Geffen School of Medicine at the University of California Los Angeles, Ronald Reagan University of California Los Angeles Medical Center, Los Angeles, California.

3. Associate Professor of Clinical Anesthesiology and Internal Medicine; Director of Clinical Research; Chief, Division of Perioperative Medicine; University of Miami School of Medicine, Miami, Florida.

4. Professor and Head, University of British Columbia Department of Anesthesiology, Pharmacology and Therapeutics, St. Paul's Hospital, Vancouver, British Columbia, Canada.

5. Professor of Anesthesiology and Perioperative Medicine, Department of Anesthesiology, Oregon Health and Science University, Portland, Oregon.

6. Professor, Department of Anesthesiology and Pain Medicine, University of Texas M.D. Anderson Cancer Center, Houston, Texas.

Abstract

Background Rocuronium in intubation doses provides similar intubation conditions as succinylcholine, but has a longer duration of action. This study compared time to sugammadex reversal of profound rocuronium-induced neuromuscular block with time to spontaneous recovery from succinylcholine. Methods One hundred and fifteen adult American Society of Anesthesiologists Class I-II surgical patients were randomized to this multicenter, safety-assessor-blinded, parallel group, active-controlled, Phase IIIa trial. Anesthesia was induced and maintained with propofol and an opioid. Neuromuscular transmission was blocked and tracheal intubation facilitated with 1.2 mg/kg rocuronium or 1 mg/kg succinylcholine. Sugammadex (16 mg/kg) was administered 3 min after rocuronium administration. Neuromuscular function was monitored by acceleromyography. The primary efficacy endpoint was the time from the start of relaxant administration to recovery of the first train-of-four twitch (T(1)) to 10%. Results One hundred and ten patients received study treatment. Mean times to recovery of (T(1)) to 10% and (T(1)) to 90% were significantly faster in the rocuronium-sugammadex group (4.4 and 6.2 min, respectively), as compared with the succinylcholine group (7.1 and 10.9 min, respectively; all P < 0.001). Timed from sugammadex administration, the mean time to recovery of (T(1)) to 10%, (T(1)) to 90%, and the train-of-four (T(4)/T(1)) ratio to 0.9 was 1.2, 2.9, and 2.2 min, respectively. Reoccurrence of the block was not observed. There were no serious adverse events related to study treatments. Conclusion Reversal of profound high-dose rocuronium-induced neuromuscular block (1.2 mg/kg) with 16 mg/kg sugammadex was significantly faster than spontaneous recovery from 1 mg/kg succinylcholine.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Anesthesiology and Pain Medicine

Reference32 articles.

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