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Sugammadex Provides Faster Reversal of Vecuronium-Induced Neuromuscular Blockade Compared with Neostigmine: A Multicenter, Randomized, Controlled Trial

Karin S. Khuenl-Brady, MD^*, Magnus Wattwil, MD, Bernard F. Vanacker, MD, José I. Lora-Tamayo, MD, Henk Rietbergen, MSc^||, and José A. Álvarez-Gómez, MD^¶

From the *Medical University Innsbruck, Innsbruck, Austria; Universitetssjukhuset Örebro, Örebro, Sweden; Universitair Ziekenhuis Leuven, Gasthuisberg, Leuven, Belgium; Hospital Universitario Puerta de Hierro, Madrid, Spain; ||Schering-Plough, Oss, The Netherlands; and ¶Hospital Universitario, Cartagena, Spain.

Address correspondence to Karin S. Khuenl-Brady, MD, DEAA, Medical University Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria. Address e-mail to karin.khuenl-brady{at}i-med.ac.at.

Abstract

Background: Sugammadex, a specifically designed -cyclodextrin, is a selective relaxant binding drug that rapidly reverses rocuronium-induced and, to a lesser extent, vecuronium-induced neuromuscular blockade. In this study, we compared the efficacy of sugammadex and neostigmine for the reversal of vecuronium-induced neuromuscular blockade in patients scheduled for elective surgery.

Methods: Patients aged 18 yr, ASA Class I–III, and scheduled for a surgical procedure under sevoflurane/opioid anesthesia received an intubating dose of vecuronium (0.1 mg/kg) and maintenance doses of 0.02–0.03 mg/kg at reappearance of the second twitch (T₂) of train-of-four (TOF) if required. Neuromuscular blockade was monitored using acceleromyography (TOF-Watch® SX, Schering-Plough Ireland, Dublin, Ireland). At end of surgery, at reappearance of T₂ after the last dose of vecuronium, patients were randomized to receive either sugammadex (2 mg/kg) or neostigmine (50 µg/kg) plus glycopyrrolate (10 µg/kg) IV. The primary efficacy end-point was time from start of administration of sugammadex or neostigmine to recovery of TOF ratio to 0.9.

Results: The geometric mean time to recovery of the TOF ratio to 0.9 was significantly faster with sugammadex compared with neostigmine (2.7 min [95% confidence interval {CI}]: 2.2–3.3) versus 17.9 min [95% CI: 13.1–24.3], respectively; P < 0.0001). The mean recovery times to a TOF ratio of 0.8 and 0.7 were also significantly shorter with sugammadex. No serious adverse events or unexpected side effects were reported with either drug.

Conclusion: Sugammadex provided significantly faster reversal of vecuronium-induced neuromuscular blockade compared with neostigmine.