alexa Residual Neuromuscular Blockade at Extubation: A Randomized Comparison of Sugammadex and Neostigmine Reversal of Rocuronium-Induced Blockade in Patients Undergoing Abdominal Surgery | Abstract
ISSN: 2155-6148

Journal of Anesthesia & Clinical Research
Open Access

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Research Article

Residual Neuromuscular Blockade at Extubation: A Randomized Comparison of Sugammadex and Neostigmine Reversal of Rocuronium-Induced Blockade in Patients Undergoing Abdominal Surgery

Daniel Sabo1*, R. Kevin Jones2, James Berry3, Tod Sloan4, Jin-Yi Chen5, Jovino B Morte5 and Scott Groudine6

1University of Pittsburgh Medical Center, Pittsburgh, PA, USA

2Saddleback Memorial Medical Center, Laguna Hills, CA, USA

3Vanderbilt University Medical Center, Nashville, TN, USA

4University of Colorado at Denver, Aurora, CO, USA

5Merck Sharp & Dohme Corp., Whitehouse Station, NJ, USA

6Department of Anesthesiology, Albany Medical Center, Albany, NY, USA

*Corresponding Author:
Daniel Sabo
UPMC Presbyterian Shadyside Hospital
Shadyside Campus, 5230 Centre Avenue
Pittsburgh, PA 15232, USA
Tel: 412 623 2167
Fax: 412 623 4188
E-mail: [email protected]

Received Date: March 15, 2011; Accepted Date: May 20, 2011; Published Date: June 02, 2011

Citation: Sabo D, Jones RK, Berry J, Sloan T, Chen JY et al. (2011) Residual Neuromuscular Blockade at Extubation: A Randomized Comparison of Sugammadex and Neostigmine Reversal of Rocuronium-Induced Blockade in Patients Undergoing Abdominal Surgery. J Anesthe Clinic Res 2:140. doi: 10.4172/2155-6148.1000140

Copyright: © 2011 Sabo D, 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: Residual neuromuscular blockade (NMB) is associated with increased risk of post-operative critical respiratory events. We compared incidence of residual NMB at tracheal extubation after reversal of rocuroniuminduced NMB with sugammadex versus neostigmine.

Methods: Adult patients of American Society of Anesthesiologists Class 1-3, scheduled to undergo open abdominal surgery were included. Patients were randomized to receive sugammadex 4.0 mg/kg at ≥1-2 posttetanic counts after last rocuronium dose, or neostigmine 50mg/kg + glycopyrrolate 10mg/kg, according to usual care practices at each institution. Neuromuscular function was assessed using TOF-Watch® SX. Anesthesiologists were blinded to the TOF-Watch recording, except to ask the TOF-Watch operator whether ≥1 PTC had been reached before administering reversal. Use of a peripheral nerve stimulator was permitted. Clinical criteria defined by the institution were used to determine when to perform extubation. Primary efficacy variable was incidence of residual NMB (train-of-four [TOF] ratio <0.9) at extubation. Safety parameters were assessed by a blinded safety assessor.

Results: The intent-to-treat group comprised 97 patients (sugammadex, n=51; neostigmine, n=46). Among patients with valid TOF data, a TOF ratio of ≥0.9 was reached at or before extubation in 48 of 50 (96.0%) sugammadex and 17 of 43 (39.5%) neostigmine patients (P<0.0001). One sugammadex (2.0%) and 15 neostigmine patients (34.9%) were extubated at TOF ratios ≤0.7. Median (95% CI) time from study drug administration to recovery to a TOF ratio ≥0.9 was 2.0 (1.8-2.5) minutes for sugammadex (n=49) versus 8.0 (3.8-16.5) minutes for neostigmine (n=18) (P<0.0001). Safety was comparable between groups, with no clinical evidence of recurrence of NMB.

Conclusions: Significantly more sugammadex-treated patients recovered to a TOF ratio ≥0.9 at extubation and did so significantly faster than neostigmine-treated patients. This study confirms that sugammadex is more effective than neostigmine in reducing potential for residual blockade in the absence of objective NMB monitoring.

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