Reversal of profound neuromuscular block by sugammadex administered three minutes after rocuronium: a comparison with spontaneous recovery from succinylcholine.
BACKGROUND
Rocuronium in intubation doses provides similar intubation conditions as succinylcholine, but has a longer duration of action. This study compared time to sugammadex reversal of profound rocuronium-induced neuromuscular block with time to spontaneous recovery from succinylcholine.


METHODS
One hundred and fifteen adult American Society of Anesthesiologists Class I-II surgical patients were randomized to this multicenter, safety-assessor-blinded, parallel group, active-controlled, Phase IIIa trial. Anesthesia was induced and maintained with propofol and an opioid. Neuromuscular transmission was blocked and tracheal intubation facilitated with 1.2 mg/kg rocuronium or 1 mg/kg succinylcholine. Sugammadex (16 mg/kg) was administered 3 min after rocuronium administration. Neuromuscular function was monitored by acceleromyography. The primary efficacy endpoint was the time from the start of relaxant administration to recovery of the first train-of-four twitch (T(1)) to 10%.


RESULTS
One hundred and ten patients received study treatment. Mean times to recovery of (T(1)) to 10% and (T(1)) to 90% were significantly faster in the rocuronium-sugammadex group (4.4 and 6.2 min, respectively), as compared with the succinylcholine group (7.1 and 10.9 min, respectively; all P < 0.001). Timed from sugammadex administration, the mean time to recovery of (T(1)) to 10%, (T(1)) to 90%, and the train-of-four (T(4)/T(1)) ratio to 0.9 was 1.2, 2.9, and 2.2 min, respectively. Reoccurrence of the block was not observed. There were no serious adverse events related to study treatments.


CONCLUSIONS
Reversal of profound high-dose rocuronium-induced neuromuscular block (1.2 mg/kg) with 16 mg/kg sugammadex was significantly faster than spontaneous recovery from 1 mg/kg succinylcholine.
Lee
Chingmuh
C
Department of Anesthesiology, David Geffen School of Medicine at University of California Los Angeles, Harbor/UCLA Medical Center, Torrance, CA 90509, USA. chinglee@chinglee.net
Jahr
Jonathan S
JS
Candiotti
Keith A
KA
Warriner
Brian
B
Zornow
Mark H
MH
Naguib
Mohamed
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000732:Androstanols / Q000008:administration & dosage*; D000762:Anesthesia Recovery Period; D004347:Drug Interactions / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019148:Neuromuscular Blockade / Q000379:methods*; D000077123:Rocuronium; D013390:Succinylcholine / Q000008:administration & dosage*; D000077122:Sugammadex; D013997:Time Factors; D055815:Young Adult; D047408:gamma-Cyclodextrins / Q000008:administration & dosage*
D000732:Androstanols; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D013390:Succinylcholine; D000077123:Rocuronium