Use of rocuronium–sugammadex, an alternative to succinylcholine, as a muscle relaxant during electroconvulsive therapy

Abstract

We compared the recovery time from neuromuscular blockade induced by rocuronium combined with sugammadex versus succinylcholine during electroconvulsive therapy (ECT). Anesthesia was induced using propofol, followed by succinylcholine (1 mg/kg) or rocuronium (0.6 mg/kg). Immediately after the seizure stopped, 16 mg/kg sugammadex was infused. Neuromuscular monitoring was performed and continued until recovery of the train-of-four ratio to 0.9. We compared the recovery time of T1 to 10 and 90% between groups. Patients were also assessed for clinical signs, such as time to first spontaneous breath from the administration of muscle relaxant and eye opening to verbal commands. Although recovery time of T1 to 10 and 90% in the rocuronium-sugammadex group was shorter than in the succinylcholine group, the difference was not statistically significant. Further, the seizure duration with succinylcholine (33 ± 8 s) was shorter than that with rocuronium-sugammadex (39 ± 4 s). In conclusion, this study demonstrates the potential benefit of use of rocuronium-sugammadex as an alternative to succinylcholine for muscle relaxation during ECT.

Comparison of recovery times from rocuronium-induced muscle relaxation after reversal with three different doses of sugammadex and succinylcholine during electroconvulsive therapy

“…Lee et al [2,3] reported that reversal of profound rocuronium (1.0-1.2 mg/kg)-induced neuromuscular block with a large dose of sugammadex (16 mg/kg) was significantly faster than spontaneous recovery from SCC. Previously, we showed the potential benefit of using rocuronium (0.6 mg/kg)-sugammadex (16 mg/kg) as an alternative to SCC (1 mg/kg) for muscle relaxation during ECT [4]. A large dose of rocuronium (1.0-1.2 mg/kg) is usually not needed for muscle relaxation during ECT, as shown in our previous study [4] and that of others [1].…”

“…Previously, we showed the potential benefit of using rocuronium (0.6 mg/kg)-sugammadex (16 mg/kg) as an alternative to SCC (1 mg/kg) for muscle relaxation during ECT [4]. A large dose of rocuronium (1.0-1.2 mg/kg) is usually not needed for muscle relaxation during ECT, as shown in our previous study [4] and that of others [1]. Hence, we speculated that a slightly smaller dose of sugammadex would be required for equally rapid recovery from 0.6 mg/kg rocuronium-induced muscle relaxation as from relaxation with 1 mg/kg SCC.…”

Comparison of Sugammadex and Neostigmine in Short Term Surgery

“…Sugammadeksin son zamanlarda kullanıma girdiği bir diğer uygulama da elektrokonvulsif tedavi olmuştur. Çok kısa süreli bir işlem olması nedeniyle, nöromuskuler blok için süksinilkolinin tercih edildiği bu uygulamada, gerek süksinilkolinin istenmeyen yan etkilerinden kaçınmak, gerekse psodokolinesteraz eksikliği olan hastalarda rokuronyum kullanılarak, sugammadeksin hemen uygulanabilir ve hızlı etkileri ön plana çıkmakta ve bu hastalarda giderek daha yaygın kullanıma yol açmaktadır [13][14]. Bizim çalışmamız ve daha önce değinilen, benzer çalışmalarla da desteklenen sonuçlara göre, sugammadeksin muskarinik yan etkilerden uzak bir şekilde güvenli ve nöromusküler blok düzeyi ne kadar derin olsa da uygun dozda kullanımı ile hızlı bir şekil-de etkin olduğu bir gerçektir.…”

Rocuronium and sugammadex under TOF monitoring on mECT

“…After convulsion of mECT, 0 % of TOFR is considered. Then we administered 4 mg/kg of sugammadex and the value of TOFR reached 100 % [3]. After 2 min of administration…”