“ Reversal of Vecuronium Induced Neuromuscular Block With Sugammadex Using Train of Four Mode in Patients Undergoing Surgeries Under General Anesthesia”

Abstract

BACKGROUND: Sugammadex is a modied γ-cyclodextrin, “SU” stands for sugar and “gammadex” stands for structural molecule gamacyclodextrin. It can reverse profound neuromuscular blockade and can be given for immediate reversal without waiting for the natural recovery. In a dose of 1.0 mg/kg. It can reverse Rocuronium-induced neuromuscular block which has spontaneously recovered to a train-of-four count of four. In this prospective single arm interventional clinical study, we investigated whether 1mg/kg of Sugammadex can also reverse Vecuronium induced neuromuscular blockade at a similar level of block. METHODS: Thirty one patients of 18-70 years of age who were scheduled to undergo general surgery and gynaecological procedures were enrolled. All patients received standard general anaesthesia with propofol, sevourane, fentanyl, and vecuronium. Neuromuscular function was monitored with acceleromyography (Stimupod xavant technology. Hague, Netherlands). Once the neuromuscular function recovered spontaneously to four twitches in response to train-of-four stimulation, patients were administered 1 mg/kg of Sugammadex I.V. Time from study drug injection to normalized train-of-four ratio 0.9 and the incidence of incomplete reversal within 30min were the primary outcome variables. Secondary outcome was the incidence of reparalysis with normalized train-of-four ratio less than 0.9. RESULTS: We observe that at 0 min, less than 5 percent had complete recovery of neuromuscular function, while at 5th minute, almost 97% of patients had complete recovery which maximizes to 100 percent in 15 minutes. The same total recovery is maintained until 30 minutes without any reparalysis. CONCLUSIONS: Sugammadex in a dose of 1.0mg/kg, reversed a threshold train-of-four count of four in vecuronium induced neuromuscular block without any reparalysis.