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ANESTHETIC PHARMACOLOGY

Reversal of Rocuronium-Induced Neuromuscular Block with the Novel Drug Sugammadex Is Equally Effective Under Maintenance Anesthesia with Propofol or Sevoflurane

Bernard F. Vanacker, MD, PhD^*, Karel M. Vermeyen, MD, PhD, Michel M. R. F. Struys, MD, PhD, Henk Rietbergen, MSc, Eugene Vandermeersch, MD, PhD^*, Vera Saldien, MD, Alain F. Kalmar, MD, and Martine E. Prins, MSc

From the *University Hospitals Leuven, KU Leuven, Belgium; University Hospital Antwerp, Antwerp, Belgium; Ghent University Hospital, Ghent, Belgium; NV Organon, Oss, The Netherlands.

Address correspondence and reprint requests to Bernard F. Vanacker, MD, PhD, Department of Anesthesiology, University Hospitals Leuven, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium. Address e-mail to bernard.vanacker{at}uz.kuleuven.ac.be.

In this study we investigated whether the novel reversal drug, sugammadex, is equally effective at reversing rocuronium-induced neuromuscular block (NMB) in patients under propofol or sevoflurane maintenance anesthesia. After receiving propofol for induction, patients were randomized to propofol (n = 21) or sevoflurane (n = 21). Rocuronium 0.6 mg/kg was administered for tracheal intubation. NMB was monitored using acceleromyography. At reappearance of the second twitch of the train-of-four ratio, sugammadex 2.0 mg/kg was administered by IV bolus. The primary end-point was time from start of sugammadex administration to recovery of train-of-four ratio to 0.9. Mean recovery time was 1.8 min after both propofol and sevoflurane anesthesia. The 95% confidence interval for the difference in recovery time between the 2 groups (–0.5 to +0.4 min) was well within the predefined equivalence interval (–1 to +1 min), indicating that recovery from NMB was unaffected by maintenance anesthesia. Thirteen patients (propofol n = 4; sevoflurane n = 9) experienced adverse events; these were treatment-related in 4 patients (propofol n = 3; sevoflurane n = 1). There were no treatment-related serious adverse events and no discontinuations or deaths. No residual paralysis occurred. The safety profile of sugammadex was somewhat more favorable under propofol than under sevoflurane anesthesia.

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