alexa Combined use of Sugammadex and Neostigmine for the Reversal of Rocuronium-Induced Profound Neuromuscular Blockade | OMICS International | Abstract
ISSN: 2155-6148

Journal of Anesthesia & Clinical Research
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Research Article

Combined use of Sugammadex and Neostigmine for the Reversal of Rocuronium-Induced Profound Neuromuscular Blockade

Akihito Kakinuma1*, Hirokazu Nagatani2 , Atsushi Yasuda3 , Tatsuya Yoshimura4 , Jun Sawai5 and Yoshinori Nakata6

1Teikyo University Hospital, Tokyo, Japan

2Department of Anesthesia and Critical Care, Teikyo University School of Medicine, Tokyo, Japan

3Department of Anesthesia, Massachusetts General Hospital, Boston, MA, USA

4Department of Anesthesiology, Shinyurigaoka hospital, Tokyo, Japan

5Department of Anesthesiology, The Cardiovascular Institute Tokyo, Japan

6Teikyo University Graduate School of Public Health Tokyo, Japan

*Corresponding Author:
Akihito Kakinuma
Teikyo University Hospital, Tokyo, Japan
Tel: +81-3-3964-1211
Fax: +81-3-3963-2687
E-mail: [email protected]

Received date: June 03, 2013; Accepted date: June 27, 2013; Published date: June 29, 2013

Citation: Kakinuma A, Nagatani H, Yasuda A, Yoshimura T, Sawai J, et al. (2013) Combined use of Sugammadex and Neostigmine for the Reversal of Rocuronium- Induced Profound Neuromuscular Blockade. J Anesthe Clinic Res 4:337. doi: 10.4172/2155-6148.1000337

Copyright: © 2013 Kakinuma A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Background: Sugammadex is a new reversal agent for nondepolarizing neuromuscular blockade. We conducted the randomized clinical study to compare the recovery between sugammadex alone and combined use of sugammadex and neostigmine.

Methods: Forty adult patients were randomly allocated to Group S (n=20) or Group SN (n=20). General anesthesia was induced and maintained with propofol and remifentanil. The patients were intubated without neuromuscular blockers. After the stabilization of TOF Watch SX® acceleromyography as control, rocuronium 0.6 mg/kg was administered to patients in both groups. The patients in Group S received sugammadex 1.0 mg/kg and those in Group SN received sugammadex 0.5 mg/kg, neostigmine 0.04 mg/kg and atropine 0.02 mg/kg five minutes after rocuronium administration. The cost of reversal and recovery time were measured in both groups.

Results: We analyzed the data of 36 patients (n=18 in each group). The T1/control ratios were significantly higher in Group SN than in group S at 5, 10 and 15minutes after administration of reversal agents. The TOF ratios were significantly higher in Group SN than in group S at 10 and 15minutes after administration of reversal agents. The 90% recovery time of TOF ratio in Group SN was significantly shorter than that in Group S. The cost of reversal was significantly smaller in Group SN than in Group S.

Conclusions: By partially substituting sugammadex with neostigmine, we can attain faster recovery from rocuronium-induced profound neuromuscular blockade.

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