Reversal of profound vecuronium-induced neuromuscular block under sevoflurane anesthesia: sugammadex versus neostigmine

Abstract

BackgroundAcetylcholinesterase inhibitors cannot rapidly reverse profound neuromuscular block. Sugammadex, a selective relaxant binding agent, reverses the effects of rocuronium and vecuronium by encapsulation. This study assessed the efficacy of sugammadex compared with neostigmine in reversal of profound vecuronium-induced neuromuscular block under sevoflurane anesthesia.MethodsPatients aged ≥18 years, American Society of Anesthesiologists class 1-4, scheduled to undergo surgery under general anesthesia were enrolled in this phase III, multicenter, randomized, safety-assessor blinded study. Sevoflurane anesthetized patients received vecuronium 0.1 mg/kg for intubation, with maintenance doses of 0.015 mg/kg as required. Patients were randomized to receive sugammadex 4 mg/kg or neostigmine 70 μg/kg with glycopyrrolate 14 μg/kg at 1-2 post-tetanic counts. The primary efficacy variable was time from start of study drug administration to recovery of the train-of-four ratio to 0.9. Safety assessments included physical examination, laboratory data, vital signs, and adverse events.ResultsEighty three patients were included in the intent-to-treat population (sugammadex, n = 47; neostigmine, n = 36). Geometric mean time to recovery of the train-of-four ratio to 0.9 was 15-fold faster with sugammadex (4.5 minutes) compared with neostigmine (66.2 minutes; p < 0.0001) (median, 3.3 minutes with sugammadex versus 49.9 minutes with neostigmine). No serious drug-related adverse events occurred in either group.ConclusionsRecovery from profound vecuronium-induced block is significantly faster with sugammadex, compared with neostigmine. Neostigmine did not rapidly reverse profound neuromuscular block (Trial registration number: NCT00473694).

Comparison of Decurarization Using Sugammadex and Neostigmine After Rocuronium During Desflurane Anesthesia

“…Although sugammadex group had no heart rate changes, neostigmine had signifi cant heart rate increases 3,12 .…”

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

“…In contrast to neostigmine, sugammadex (Bridion Ò , Merck Sharp and Dohme (MSD), Oss, the Netherlands) has the potential to achieve reliable, complete and rapid reversal of both moderate and deep rocuronium-and vecuronium-induced neuromuscular blockade [3][4][5][6].…”

Comparison of Sugammadex and Neostigmine in Short Term Surgery

“…Lemmens HJM ve ark. [6]; ait bir çalısmada sugammadeksin kan basıncı, kalp hızı solunum ve termoregülasyon üzerinde önemli bir etkiye yol açmadığı saptanmıştır. Rokuronyum ve vekuronyumun idame dozları ile elde edilen nöromusküler bloğun geri dön-dürülmesi için neostigmin ve sugammadeks alan hastalarda yapılan randomize faz 3 çalışmada sugammadeks kalp hızı üzerin-de anlamlı hiçbir etki oluşturmamıştır.…”