title: Reversal of rocuronium-induced neuromuscular block with the novel drug sugammadex is equally effective under maintenance anesthesia with propofol or sevoflurane.
abstract: In this study we investigated whether the novel reversal drug, sugammadex, is equally effective at reversing rocuronium-induced neuromuscular block (NMB) in patients under propofol or sevoflurane maintenance anesthesia. After receiving propofol for induction, patients were randomized to propofol (n = 21) or sevoflurane (n = 21). Rocuronium 0.6 mg/kg was administered for tracheal intubation. NMB was monitored using acceleromyography. At reappearance of the second twitch of the train-of-four ratio, sugammadex 2.0 mg/kg was administered by IV bolus. The primary end-point was time from start of sugammadex administration to recovery of train-of-four ratio to 0.9. Mean recovery time was 1.8 min after both propofol and sevoflurane anesthesia. The 95% confidence interval for the difference in recovery time between the 2 groups (-0.5 to +0.4 min) was well within the predefined equivalence interval (-1 to +1 min), indicating that recovery from NMB was unaffected by maintenance anesthesia. Thirteen patients (propofol n = 4; sevoflurane n = 9) experienced adverse events; these were treatment-related in 4 patients (propofol n = 3; sevoflurane n = 1). There were no treatment-related serious adverse events and no discontinuations or deaths. No residual paralysis occurred. The safety profile of sugammadex was somewhat more favorable under propofol than under sevoflurane anesthesia.
authors.affiliation: Department of Anesthesiology, University Hospitals Leuven, KU Leuven, Leuven, Belgium. bernard.vanacker@uz.kuleuven.ac.be
authors.forename: Bernard F
authors.initials: BF
authors.lastname: Vanacker
authors.forename: Karel M
authors.initials: KM
authors.lastname: Vermeyen
authors.forename: Michel M R F
authors.initials: MM
authors.lastname: Struys
authors.forename: Henk
authors.initials: H
authors.lastname: Rietbergen
authors.forename: Eugene
authors.initials: E
authors.lastname: Vandermeersch
authors.forename: Vera
authors.initials: V
authors.lastname: Saldien
authors.forename: Alain F
authors.initials: AF
authors.lastname: Kalmar
authors.forename: Martine E
authors.initials: ME
authors.lastname: Prins
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000732:Androstanols / Q000008:administration & dosage / Q000037:antagonists & inhibitors*; D000768:Anesthesia, General; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage*; D008875:Middle Aged; D019148:Neuromuscular Blockade / Q000379:methods*; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage / Q000037:antagonists & inhibitors*; D015742:Propofol / Q000008:administration & dosage*; D000077123:Rocuronium; D000077149:Sevoflurane; D016037:Single-Blind Method; D000077122:Sugammadex; D013997:Time Factors; D014132:Trachea / Q000473:pathology; D047408:gamma-Cyclodextrins / Q000008:administration & dosage*
chemical_list: D000732:Androstanols; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D003473:Neuromuscular Nondepolarizing Agents; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D000077149:Sevoflurane; D000077123:Rocuronium; D015742:Propofol