Effective Reversal of Moderate Rocuronium- or Vecuronium-induced Neuromuscular Block with Sugammadex, a Selective Relaxant Binding Agent

Suy, Koen; Morias, Karl; Cammu, Guy; Hans, Pol; Duijnhoven, Wilbert G. F. van; Heeringa, Marten; Demeyer, Ignace

doi:10.1097/00000542-200702000-00016

Cited by 187 publications

(112 citation statements)

References 15 publications

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“…Similar uncertainty remains regarding the ideal dosing of sugammadex, which would prevent residual curarization. While some studies [14] recommend dosing sugammadex at 2 mg.kg -1 total body weight if two twitches are present in the TOF count, Van Lanke [15] found that the appropriate dose should be calculated on the basis of ideal body weight according to the formula "Ideal body weight plus 40% of the excess weight". This means that though some of our patients were suboptimally dosed on a total body weight basis, they still received enough sugammadex according to Van Lanker's recommended dosage.…”

Section: Discussionmentioning

confidence: 99%

Residual curarization and postoperative respiratory complications following laparoscopic sleeve gastrectomy. The effect of reversal agents: sugammadex vs. neostigmine

Ezri

Evron

Petrov

et al. 2015

The Journal of Critical Care Medicine

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Background: Incomplete muscle relaxant reversal or re-curarization may be associated with postoperative respiratory complications. In this retrospective study we compared the incidence of postoperative residual curarization and respiratory complications in association with the type of muscle relaxant reversal agent, sugammadex or neostigmine, in patients undergoing laparoscopic sleeve gastrectomy. Material and methods:We reviewed the charts of all patients (179) undergoing laparoscopic sleeve gastrectomy from July 2012 to July 2013 at Wolfson Medical Center. Sugammadex 1.5-2 mg/kg (112 patients) or neostigmine 2.5 mg (67 patients) were used as reversal agents. Results were compared by the type of reversal agent employed. Compared parameters included demographic and anaesthetic data, residual curarization, oxyhemoglobin saturation (SpO 2 ) in the recovery room (PACU), episodes of SpO 2 lower than 90% in PACU, unexpected intensive care (ICU) admissions, incidence of atelectasis and pneumonia, re-intubation and duration of hospitalization. Results: Obstructive sleep apnea syndrome (OSAS) was more frequent in the sugammadex group (19% vs. 8%; p = 0.026). Total intravenous anesthesia (TIVA) was more frequently associated with sugammadex (33% vs. 16%; p = 0.007). There were no differences in postoperative residual curarization, SpO 2 < 90% episodes, reintubation, ICU admissions, pulmonary complications and duration of hospitalization. Conclusion: With the inherent limitations of a retrospective study, the use of sugammadex following laparoscopic sleeve gastrectomy showed no advantage over neostigmine in terms of residual curarization and respiratory complications.

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Section: Discussionmentioning

confidence: 99%

Residual curarization and postoperative respiratory complications following laparoscopic sleeve gastrectomy. The effect of reversal agents: sugammadex vs. neostigmine

Ezri

Evron

Petrov

et al. 2015

The Journal of Critical Care Medicine

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“…The efficacy and safety of sugammadex have been established in various clinical trials [4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Treatment options for sugammadex include rapid reversal at 3 min after rocuronium using 16 mg kg -1 sugammadex, deep blockade reversal using 4 mg kg -1 sugammadex administered at recovery to one or two post-tetanic counts or 15 min post 0.6 mg kg -1 rocuronium and moderate blockade reversal using 2 mg kg -1 at reappearance of the second twitch (T2) of the train-of-four (TOF) monitoring.…”

Section: Introductionmentioning

confidence: 99%

Population pharmacokinetic–pharmacodynamic analysis for sugammadex‐mediated reversal of rocuronium‐induced neuromuscular blockade

Kleijn¹,

Zollinger

Heuvel

et al. 2011

Brit J Clinical Pharma

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WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Pharmacokinetics and pharmacodynamics of rocuronium are well known.• A mechanistical pharmacokineticpharmacodynamic model based on limited data describing rocuronium and sugammadex pharmacokinetics has been published.• However, the available pharmacokineticpharmacodynamic model for the effects of sugammadex on rocuronium-induced neuromuscular blockade has limited predictive power. WHAT THIS STUDY ADDS• A pharmacokinetic-pharmacodynamic model is described for rocuronium and sugammadex, based on physiological principles and on data covering a wide range of ages and renal function. From this model, more accurate predictions can be made about sugammadex-mediated reversal of rocuronium-induced neuromuscular blockade, in unexplored regimens or populations. AIMSAn integrated population pharmacokinetic-pharmacodynamic model was developed with the following aims: to simultaneously describe pharmacokinetic behaviour of sugammadex and rocuronium; to establish the pharmacokinetic-pharmacodynamic model for rocuronium-induced neuromuscular blockade and reversal by sugammadex; to evaluate covariate effects; and to explore, by simulation, typical covariate effects on reversal time. METHODSData (n = 446) from eight sugammadex clinical studies covering men, women, non-Asians, Asians, paediatrics, adults and the elderly, with various degrees of renal impairment, were used. Modelling and simulation techniques based on physiological principles were applied to capture rocuronium and sugammadex pharmacokinetics and pharmacodynamics and to identify and quantify covariate effects. RESULTSSugammadex pharmacokinetics were affected by renal function, bodyweight and race, and rocuronium pharmacokinetics were affected by age, renal function and race. Sevoflurane potentiated rocuronium-induced neuromuscular blockade. Posterior predictive checks and bootstrapping illustrated the accuracy and robustness of the model. External validation showed concordance between observed and predicted reversal times, but interindividual variability in reversal time was pronounced. Simulated reversal times in typical adults were 0.8, 1.5 and 1.4 min upon reversal with sugammadex 16 mg kg -1 3 min after rocuronium, sugammadex 4 mg kg -1 during deep neuromuscular blockade and sugammadex 2 mg kg -1 during moderate blockade, respectively. Simulations indicated that reversal times were faster in paediatric patients and slightly slower in elderly patients compared with adults. Renal function did not affect reversal time. CONCLUSIONSSimulations of the therapeutic dosing regimens demonstrated limited impact of age, renal function and sevoflurane use, as predicted reversal time in typical subjects was always <2 min.

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“…13 Also, moderate (T 2 ) rocuronium-and vecuronium-induced neuromuscular blocks were successfully reversed under propofol-remifentanil anesthesia. 4 A multicenter study 9 demonstrated a clear dose-response relationship for the reversal of moderate rocuronium-and vecuronium-induced neuromuscular block with sugammadex 0.5, 1.0, 2.0, and 4.0 mg/kg under sevoflurane anesthesia. Recovery times to TOF ratio 0.9 were shorter in the rocuronium versus the vecuronium group, and the difference was the most pronounced at sugammadex 0.5 mg/kg.…”

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confidence: 99%

Reversal of Vecuronium-induced Neuromuscular Blockade with Low-dose Sugammadex at Train-of-four Count of Four

et al. 2017

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Background Rocuronium-induced neuromuscular block that spontaneously recovered to a train-of-four count of four can be reversed with sugammadex 0.5 or 1.0 mg/kg. We investigated whether these doses of sugammadex can also reverse vecuronium at a similar level of block. Methods Sixty-five patients were randomly assigned, and 64 were analyzed in this controlled, superiority study. Participants received general anesthesia with propofol, sevoflurane, fentanyl, and vecuronium. Measurement of neuromuscular function was performed with acceleromyography (TOF-Watch-SX, Organon Teknika B.V., The Netherlands ). Once the block recovered spontaneously to four twitches in response to train-of-four stimulation, patients were randomly assigned to receive sugammadex 0.5, 1.0, or 2.0 mg/kg; neostigmine 0.05 mg/kg; or placebo. Time from study drug injection to normalized train-of-four ratio 0.9 and the incidence of incomplete reversal within 30 min were the primary outcome variables. Secondary outcome was the incidence of reparalysis (normalized train-of-four ratio less than 0.9). Results Sugammadex, in doses of 1.0 and 2.0 mg/kg, reversed a threshold train-of-four count of four to normalized train-of-four ratio of 0.9 or higher in all patients in 4.4 ± 2.3 min (mean ± SD) and 2.6 ± 1.6 min, respectively. Sugammadex 0.5 mg/kg reversed the block in 6.8 ± 4.1 min in 70% of patients (P < 0.0001 vs. 1.0 and 2.0 mg/kg), whereas neostigmine produced reversal in 11.3 ± 9.7 min in 77% of patients (P > 0.05 vs. sugammadex 0.5 mg/kg). The overall frequency of reparalysis was 18.7%, but this incidence varied from group to group. Conclusions Sugammadex 1.0 mg/kg, unlike 0.5 mg/kg, properly reversed a threshold train-of-four count of four vecuronium-induced block but did not prevent reparalysis.

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Effective Reversal of Moderate Rocuronium- or Vecuronium-induced Neuromuscular Block with Sugammadex, a Selective Relaxant Binding Agent

Abstract: Sugammadex rapidly reversed rocuronium- or vecuronium-induced neuromuscular block at reappearance of the second muscle twitch and was well tolerated. A dose-response relation was observed with sugammadex for reversal of both rocuronium- and vecuronium-induced neuromuscular block.

Cited by 187 publications

References 15 publications

Residual curarization and postoperative respiratory complications following laparoscopic sleeve gastrectomy. The effect of reversal agents: sugammadex vs. neostigmine

Residual curarization and postoperative respiratory complications following laparoscopic sleeve gastrectomy. The effect of reversal agents: sugammadex vs. neostigmine

Population pharmacokinetic–pharmacodynamic analysis for sugammadex‐mediated reversal of rocuronium‐induced neuromuscular blockade

Reversal of Vecuronium-induced Neuromuscular Blockade with Low-dose Sugammadex at Train-of-four Count of Four

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