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

Abstract

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.

Sugammadex: A Review of Neuromuscular Blockade Reversal

“…Randomized, safety assessor-blind, multicentre trials examined the efficacy of sugammadex administered at 1-2 PTCs for the reversal of deep neuromuscular blockade [49][50][51][52][53]. The trials included adults who were ASA physical status I-III [49,52,53] or I-IV [50,51] and undergoing surgery [50][51][52], laparoscopic surgery [49] or outpatient surgery [53] under general anaesthesia induced by propofol and maintained by propofol [49], sevoflurane [50,51] or inhalational agents [53], with opioids also permitted, or according to local practice [52].…”

“…The trials included adults who were ASA physical status I-III [49,52,53] or I-IV [50,51] and undergoing surgery [50][51][52], laparoscopic surgery [49] or outpatient surgery [53] under general anaesthesia induced by propofol and maintained by propofol [49], sevoflurane [50,51] or inhalational agents [53], with opioids also permitted, or according to local practice [52]. Intravenous sugammadex 4 mg/kg was compared with neostigmine 50 or 70 lg/kg plus glycopyrrolate [50,51] or atropine [49], with placebo [52], or with spontaneous recovery [53].…”

Neuromuscular Block and Blocking Agents in 2018

“…Whereas reversing of a vecuronium-induced deep NMB with sugammadex 4 mg kg -1 has a slower progress (4.5 min) and a wider range (1.4-68.4 min) of recovery (31). Recreation period is less variable with sugammadex 94-95% of sugammadex recipients recover within 5 min, whereas just 20% of patients recieving neostigmine (53,54).…”

The philosophy of rapid rehabilitation in thoracoabdominal surgery

“…Для профилактики дыхатель-ных осложнений (в том числе микроаспирации) важны немедленная или ранняя экстубация, санация ротоглотки интраоперационно, отказ от рутинной постановки назо-гастрального зонда или максимально раннее его удаление. В обеспечении немедленной экстубации и снижении ча-стоты дыхательных осложнений важную роль играет свое-временное и полное восстановление защитных функций гортаноглотки посредством мониторинга и реверсии нервно-мышечного блока, обязательной декураризации в конце операции с помощью неостигмина или использова-ния пары рокуроний -суггамадекс [32,[34][35][36].…”