Postoperative impairment of motor function at train-of-four ratio ≥0.9 cannot be improved by sugammadex (1 mg kg−1)

Baumüller, E.; Schaller, Stefan J.; Lama, Y. Chiquito; Frick, Christiane G.; Bauhofer, T.; Eikermann, Matthias; Fink, Heidrun; Blobner, Manfred

doi:10.1093/bja/aeu453

Cited by 24 publications

(15 citation statements)

References 44 publications

(25 reference statements)

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“…Although faster in action than neostigmine, these slower rates of recovery detract from the benefits of sugammadex over neostigmine in reversing residual neuromuscular block. Baumuller and colleagues 66 administered sugammadex 1 mg kg À1 at a TOFR of 0.9 in conscious patients in the recovery room and compared the effect on voluntary grip strength and fine motor function to a placebo group. They found a minimal beneficial effect on these recovery characteristics from sugammadex at this late stage of recovery.…”

Section: Low Doses Of Sugammadexmentioning

confidence: 99%

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Reversal of residual neuromuscular block: complications associated with perioperative management of muscle relaxation

Hunter

2017

British Journal of Anaesthesia

174

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The use of anticholinesterases to reverse residual neuromuscular block at the end of surgery became routine practice in the 1950s. These drugs could only be used when recovery from block was established [two twitches of the train-of-four (TOF) count detectable] and concern was expressed about their cholinergic side-effects. By the 1990s, it was recognized that failure to reverse residual block adequately to a TOF ratio (TOFR) >0.7 was associated with increased risk of postoperative pulmonary complications (POPCs) following the long-acting non-depolarizing neuromuscular blocking drug (NDNMBD) pancuronium. By 2003, and the introduction of acceleromyography, a TOFR ≥0.9 was considered necessary to protect the airway from aspiration before tracheal extubation. It was also considered that four, not two, twitches of the TOF should be detectable before neostigmine was given. Use of any NDNMBD was subsequently shown to be associated with increased risk of POPCs, but it was thought that neostigmine reduced that risk. Recently, there has been conflicting evidence that use of neostigmine might increase the incidence of POPCs. Although sugammadex has been shown to rapidly reverse profound neuromuscular block from aminosteroidal agents, there is currently no evidence that sugammadex is superior to neostigmine in its effect on POPCs. Other new antagonists, including cysteine to degrade CW002 and calabadion 1 and 2 to antagonize aminosteroidal and benzylisoquinolium NDNMBDs, are being studied in preclinical and clinical trials. Quantitative neuromuscular monitoring is essential whenever a NDNMBD is used to ensure full recovery from neuromuscular block.

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Section: Low Doses Of Sugammadexmentioning

confidence: 99%

“…In both groups there was some improvement in grip strength and motor function but they did not return to preoperative baseline values. 66 These findings could have been a result of the ongoing spontaneous recovery from the NDNMBD. Care must be taken if lower doses of sugammadex are used often in an effort to reduce cost.…”

Section: Low Doses Of Sugammadexmentioning

confidence: 99%

Reversal of residual neuromuscular block: complications associated with perioperative management of muscle relaxation

Hunter

2017

British Journal of Anaesthesia

174

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“…Therefore, consistent with the result of other studies on post-operative quality of recovery, there was no difference in pain recovery between the two groups across all time points. [7,21] An advantage of sugammadex for PONV has also been reported by several studies. [8,22,23] Cholinergic effects from the use of cholinesterase inhibitors can cause a decrease in oesophageal tone, and an increase in secretion and intestinal movement that might be associated with the increased PONV.…”

Section: Discussionmentioning

confidence: 65%

Influence of Reversal with Sugammadex or Neostigmine on Post-Operative Quality of Recovery Following a Single Bolus Dose of Rocuronium: A Prospective, Randomised, Double-Blinded, Controlled Study

Bai¹,

Lee²,

Ss³

et al. 2018

Preprint

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There is a lack of data comparing sugammadex with anticholinesterase for the quality of anaesthesia recovery, especially following a single bolus dose of rocuronium. Thus, we evaluated the influence of reversal with sugammadex or neostigmine on post-operative quality of recovery by using the Post-operative Quality Recovery Scale (PQRS). A total of 86 patients undergoing trans-pars plana vitrectomy (TPPV) under general anaesthesia were intubated following a single bolus dose of rocuronium (0.6 mg/kg). At the end of surgery, patients were received either neostigmine or sugammadex. The quality of recovery was assessed using the PQRS at 15 minutes and 40 minutes after surgery, and on post-operative day 1. The recovery rate in the physiological domain was higher in the sugammadex group at 15 minutes after surgery (P = 0.02). Though there were no significant differences in the overall cognitive recovery domain, patients in the sugammadex group could recall more numbers in reverse order. However, there were no significant differences between the groups in the other domains of the PQRS. The use of sugammadex may increase the quality of the post-operative physiological recovery at early post-operative periods compared with neostigmine use following a single bolus dose of rocuronium in patients undergoing TPPV with general anaesthesia.

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“…So quantitative monitoring is essential throughout to examine the reversing success (TOFR ≥0.9) (44,49,65,66).…”

Section: Debatementioning

confidence: 99%

“…However current studies identified that appropriate dosing of neostigmine for reversing of residual paralysis is able to eleminate effectively the incidence of respiratory complications and that the application of sugammadex 1.0 mg kg -1 at a TOFR ≥0.9 does not improve patient´s motor function (9,12,35,66). Murphy and colleagues revealed in a clinical setting that application of neostigmine 0.04 mg kg -1 at a TOFR of ≥0.9 did not raise the incidence of postoperative muscle weakness, hypoxemia and airway obstruction (74).…”

Section: Debatementioning

confidence: 99%

Neuromuscular Block and Blocking Agents in 2018

Unterbuchner

2018

Turk J Anaesth Reanim

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Postoperative impairment of motor function at train-of-four ratio ≥0.9 cannot be improved by sugammadex (1 mg kg−1)

Abstract: The trial is registered at ClinicalTrials.gov (NCT01101139).

Cited by 24 publications

References 44 publications

Reversal of residual neuromuscular block: complications associated with perioperative management of muscle relaxation

Reversal of residual neuromuscular block: complications associated with perioperative management of muscle relaxation

Influence of Reversal with Sugammadex or Neostigmine on Post-Operative Quality of Recovery Following a Single Bolus Dose of Rocuronium: A Prospective, Randomised, Double-Blinded, Controlled Study

Neuromuscular Block and Blocking Agents in 2018

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