Reversibility of Rocuronium-Induced Deep Neuromuscular Block with Sugammadex in Infants and Children—A Randomized Study

Abstract

Sugammadex 4 mg•kg 1 is recommended for reversal from rocuronium-induced deep neuromuscular block. However, there is limited data regarding the dose-response of sugammadex required for reversal from deep neuromuscular block in pediatric patients. The aim of this study was to determine the reversibility of rocuronium-induced deep neuromuscular block with sugammadex in infants and children. Seventy-five children (48 infants and 27 children, mean standard deviation (S.D.), age: 11.6 (6.7) months) were enrolled in this study. After induction of anesthesia and administration of 0.6 mg•kg 1 rocuronium, neuromuscular block was acceleromyographically evaluated by observing contractions of the adductor pollicis muscle to ulnar nerve train-of-four (TOF) stimulation. Subsequently, the intensity of rocuronium-induced block was determined every 6 min using post-tetanic count (PTC) stimulation during sevoflurane and remifentanil anesthesia. When the first response to the PTC stimulus was detected, either 1, 2 or 4 mg•kg 1 sugammadex was administered and the time required for facilitated recovery to a TOF ratio of 0.9 following each dose was compared. The time [mean (S.D.)] from the administration of 1 mg•kg 1 sugammadex until recovery to a TOF ratio of 0.9 was significantly longer [129.1 (83.5) s, p < 0.001] than that with 2 and 4 mg•kg 1 sugammadex [70.3 (26.7) s and 68.2 (34.5) s, respectively]. Incomplete reversal was seen in 3 patients in the 1 mg•kg 1 group. The results suggested that a 4 mg•kg 1 sugammadex dose is recommended for reversal from rocuronium-induced deep neuromuscular block even in infants and children.

Effects of age on sugammadex reversal of neuromuscular blockade induced by rocuronium in Chinese children: a prospective pilot trial

“…The incidence of TOFR decreasing to < 0.9 after it had been reversed to ≥0.9 via sugammadex administration (2.0 mg•kg − 1 ) was not observed in any of the patients aged 1-12 years. A previous study reported that no difference in recovery was observed between the use of 2.0 mg•kg − 1 and 4.0 mg•kg − 1 sugammadex to reverse rocuronium-induced deep neuromuscular blockade from the re-appearance of post-tetanic count to a TOFR of 0.9 in infants and children [9]. This indicates that 2.0 mg•kg − 1 sugammadex may be sufficient to fully reverse rocuronium-induced moderate neuromuscular blockade in pediatric patients aged 1-12 years.…”

“…It can encapsulate rocuronium molecules with high affinity to reverse muscle relaxation induced by steroidal nondepolarizing NMBAs [8]. Matsui M et al reported that 4 mg•kg − 1 of sugammadex can provide a complete and rapidly facilitated recovery from rocuronium-induced deep neuromuscular blockade to a TOFR of 0.9 in infants and children [9]. To date, pediatric studies are limited and have focused on using sugammadex to reverse neuromuscular blockade in pediatric patients aged 2-18 years [10,11].…”

A systematic review and meta-analysis of the effect of different doses of rocuronium for general anesthesia on thyroid surgery

“…The incidence of thyroid diseases is increasing, and surgery is the most common treatment (22)(23)(24). In case of recurrent laryngeal nerve injury, should be done immediately.…”

Recovery profile of sugammadex versus neostigmine in pediatric patients undergoing cardiac catheterization: A randomized double-blind study

“…This is in contrast to sugammadex which encapsulate rocuronium effectively leading to clearance of rocuronium molecules from the neuromuscular junction, liberating nicotinic acetylcholine receptors and restoring neuromuscular transmission. [ 18 19 20 ]…”