This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (19) Citing Articles via Google Scholar Google Scholar Articles by Sacan, O. Articles by Klein, K. Search for Related Content PubMed PubMed Citation Articles by Sacan, O. Articles by Klein, K. Related Collections Pharmacology

---

ANESTHETIC PHARMACOLOGY

Sugammadex Reversal of Rocuronium-Induced Neuromuscular Blockade: A Comparison with Neostigmine–Glycopyrrolate and Edrophonium–Atropine

From Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas.

Address correspondence and reprint requests to Paul F. White, MD, PhD, Department of Anesthesiology and Pain Management; University of Texas Southwestern Medical Center at Dallas; 5161 Harry Hines Blvd., CS 2. 282, Dallas, TX 75390-9068. Address e-mail to paul.white{at}utsouthwestern.edu.

BACKGROUND: Sugammadex is a modified cyclodextrin compound, which encapsulates rocuronium to provide for a rapid reversal of residual neuromuscular blockade. We tested the hypothesis that sugammadex would provide for a more rapid reversal of a moderately profound residual rocuronium-induced blockade than the commonly used cholinesterase inhibitors, edrophonium and neostigmine.

METHODS: Sixty patients undergoing elective surgery procedures with a standardized desflurane–remifentanil–rocuronium anesthetic technique received either sugammadex, 4 mg/kg IV (n = 20), edrophonium, 1 mg/kg IV and atropine, 10 µg/kg IV (n = 20), or neostigmine, 70 µg/kg IV and glycopyrrolate, 14 µg/kg IV (n = 20) for reversal of neuromuscular blockade at 15 min or longer after the last dose of rocuronium using acceleromyography to record the train-of-four (TOF) responses. Mean arterial blood pressure and heart rate values were recorded immediately before and for 30 min after reversal drug administration. Side effects were noted at discharge from the postanesthesia care unit.

RESULTS: The three groups were similar with respect to their demographic characteristics and total dosages of rocuronium prior to administering the study medication. Although the initial twitch heights (T₁) at the time of reversal were similar in all three groups, the time to achieve TOF ratios of 0.7 and 0.9 were significantly shorter with sugammadex (71 ± 25 and 107 ± 61 s) than edrophonium (202 ± 171 and 331 ± 27 s) or neostigmine (625 ± 341 and 1044 ± 590 s). All patients in the sugammadex group achieved a TOF ratio of 0.9 5 min after reversal administration compared with none and 5% in the edrophonium and neostigmine groups, respectively. Heart rate values at 2 and 5 min after reversal were significantly higher in the neostigmine-glycopyrrolate group compared with that in sugammadex. Finally, the incidence of dry mouth was significantly reduced in the sugammadex group (5% vs 85% and 95% in the neostigmine and edrophonium groups, respectively).

CONCLUSION: Sugammadex, 4 mg/kg IV, more rapidly and effectively reversed residual neuromuscular blockade when compared with neostigmine (70 µg/kg IV) and edrophonium (1 mg/kg IV). Use of sugammadex was associated with less frequent dry mouth than that with the currently used reversal drug combinations.

This article has been cited by other articles:

				P. F. White, B. Tufanogullari, O. Sacan, E. G. Pavlin, O. J. Viegas, H. S. Minkowitz, and M. E. Hudson The Effect of Residual Neuromuscular Blockade on the Speed of Reversal with Sugammadex Anesth. Analg., March 1, 2009; 108(3): 846 - 851. [Abstract] [Full Text] [PDF]

				L. M. Staals, M. M. J. Snoeck, J. J. Driessen, E. A. Flockton, M. Heeringa, and J. M. Hunter Multicentre, parallel-group, comparative trial evaluating the efficacy and safety of sugammadex in patients with end-stage renal failure or normal renal function Br. J. Anaesth., October 1, 2008; 101(4): 492 - 497. [Abstract] [Full Text] [PDF]

				E. A. Flockton, P. Mastronardi, J. M. Hunter, C. Gomar, R. K. Mirakhur, L. Aguilera, F. G. Giunta, C. Meistelman, and M. E. Prins Reversal of rocuronium-induced neuromuscular block with sugammadex is faster than reversal of cisatracurium-induced block with neostigmine Br. J. Anaesth., May 1, 2008; 100(5): 622 - 630. [Abstract] [Full Text] [PDF]

				G. Cammu, P. J. De Kam, I. Demeyer, M. Decoopman, P. A. M. Peeters, J. M. W. Smeets, and L. Foubert Safety and tolerability of single intravenous doses of sugammadex administered simultaneously with rocuronium or vecuronium in healthy volunteers Br. J. Anaesth., March 1, 2008; 100(3): 373 - 379. [Abstract] [Full Text] [PDF]

				P. F. White, G. Hill, and A. Lenz Where's the Fire? Anesth. Analg., September 1, 2007; 105(3): 878 - 878. [Full Text] [PDF]

				P. F. White, H. Kehlet, J. M. Neal, T. Schricker, D. B. Carr, F. Carli, and the Fast-Track Surgery Study Group The Role of the Anesthesiologist in Fast-Track Surgery: From Multimodal Analgesia to Perioperative Medical Care Anesth. Analg., June 1, 2007; 104(6): 1380 - 1396. [Abstract] [Full Text] [PDF]

				R. D. Miller Sugammadex: An Opportunity to Change the Practice of Anesthesiology? Anesth. Analg., March 1, 2007; 104(3): 477 - 478. [Full Text] [PDF]

				A. Lenz, G. Hill, and P. F. White Emergency Use of Sugammadex After Failure of Standard Reversal Drugs Anesth. Analg., March 1, 2007; 104(3): 585 - 586. [Abstract] [Full Text] [PDF]