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01-10-2009 | Anaesthesiology | Article

Sugammadex reversal of rocuronium-induced NMB unaffected by volatile anesthetics


Free abstract

MedWire News: Sugammadex is equally effective for reversing rocuronium-induced neuromuscular blockade (NMB) in patients receiving maintenance anesthesia with sevoflurane or propofol, researchers report.

Previous studies have shown that reversal of NMB induced by acetylcholinesterase inhibitors may be delayed during sevoflurane compared with propofol maintenance anesthesia, note Christopher Rex, from Klinikum am Steinenberg, Reutlingen, Germany, and colleagues.

To see whether volatile anesthetics influence the clinical effect of sugammadex, the researchers randomly assigned 52 adult patients to receive maintenance of anesthesia with sevoflurane or propofol.

NMB was induced by bolus injection of 0.6 mg/kg of rocuronium followed by an average continuous infusion of 7 µg/kg/min of rocuronium adjusted to maintain an NMB depth of zero response to train-of-four (TOF) and a posttetanic count of no more than 10 responses. At recovery of the first twitch of TOF to 3–10%, a single 4 mg/kg dose of sugammadex was administered.

All patients achieved the primary clinical effect variable of a TOF ratio of 0.9 within 2.5 minutes. The median recovery time among patients receiving sevoflurane was 1.3 minutes and 1.2 minutes for those given propofol.

The estimated difference in recovery time between the two groups was just 9 seconds and therefore recovery times were deemed to be equivalent.

The researchers note in the journal Anesthesiology that maintenance of anesthesia treatment significantly affected plasma concentrations of rocuronium. Median concentrations were 33% lower in the patients given sevoflurane than in those given propofol. Despite this effect, however, NMB was maintained to a similar degree in both groups.

There was only one adverse event thought to be related to sugammadex. This was a case of mild procedural hypotension in a patient given sevoflurane. It occurred 2 minutes after sugammadex administration and lasted for 3 minutes.

The researchers stated: “The recovery times reported in our study are faster than has been previously reported for the reversal of NMB with anticholinesterases.”

They add that, irrespective of whether anesthesia is maintained with sevoflurane or propofol, a single dose of sugammadex is effective for the reversal of rocuronium-induced NMB.

MedWire ( is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

By Lucy Piper