title: Reversal of profound rocuronium block monitored in three muscle groups with sugammadex in ponies.
abstract: BACKGROUND
  This clinical study evaluated the speed of reversal of profound rocuronium block in ponies using sugammadex and investigated the differences in onset and recovery from block in three different muscle groups.
  
  
  METHODS
  Anaesthesia was induced and maintained with isoflurane in oxygen 100% in eight ponies. Neuromuscular monitoring was performed at each site using acceleromyography: in the extensor muscles of the pelvic limb (peroneal nerve) and thoracic limb (radial nerve), and in the orbicularis oris muscle (OOM; facial nerve). Rocuronium 0.6 mg kg(-1) i.v. was administered, followed 5 min later by sugammadex 4 mg kg(-1) i.v. Onset time (onsetROC), maximum block, and time to recovery of the train-of-four ratio to 0.9 (TOFR=0.9) were recorded. The differences between monitored sites were compared using one-way anova followed by a post hoc Dunn's test.
  
  
  RESULTS
  Onset of ROC was significantly delayed in OOM compared with both limbs [pelvic limb, thoracic limb, and OOM: 43.1 (sd 16.9), 50.6 (15.9), and 204.4 (35.8) s, respectively; P<0.001]. Complete block was achieved in the pelvic and thoracic limbs, but in none of the eight ponies in the OOM [mean T1=15.3 (9.4)%; range: 7-36%]. No differences were observed between muscle sites in recovery to TOFR=0.9 [pelvic limb, thoracic limb, and OOM: 2.3 (0.9), 3.4 (1.7), and 2.8 (2.1) min, respectively]. No adverse effects of sugammadex were detected throughout the study period.
  
  
  CONCLUSIONS
  Sugammadex can be used to reverse profound rocuronium-induced block in ponies during isoflurane anaesthesia. Thoracic limb muscles represent a suitable alternative for monitoring neuromuscular block compared with pelvic limb muscles.
authors.affiliation: School of Veterinary Science, University of Liverpool, Leahurst Campus, Chester High Road, Neston CH64 7TE, UK. mmosing@liv.ac.uk
authors.forename: M
authors.initials: M
authors.lastname: Mosing
authors.forename: U
authors.initials: U
authors.lastname: Auer
authors.forename: D
authors.initials: D
authors.lastname: Bardell
authors.forename: R S
authors.initials: RS
authors.lastname: Jones
authors.forename: J M
authors.initials: JM
authors.lastname: Hunter
mesh_terms: D000732:Androstanols / Q000008:administration & dosage / Q000037:antagonists & inhibitors*; D000769:Anesthesia, Inhalation / Q000379:methods / Q000662:veterinary; D000818:Animals; D001794:Blood Pressure / Q000187:drug effects; D004334:Drug Administration Schedule; D004558:Electric Stimulation / Q000379:methods; D006339:Heart Rate / Q000187:drug effects; D006736:Horses; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods / Q000662:veterinary; D019148:Neuromuscular Blockade / Q000379:methods / Q000662:veterinary*; D009469:Neuromuscular Junction / Q000187:drug effects / Q000502:physiology; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage / Q000037:antagonists & inhibitors*; D011826:Radial Nerve / Q000502:physiology; D000077123:Rocuronium; D000077122:Sugammadex; D047408:gamma-Cyclodextrins / Q000008:administration & dosage / Q000494:pharmacology*
chemical_list: D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D000077123:Rocuronium