title: Reversal of profound vecuronium-induced neuromuscular block under sevoflurane anesthesia: sugammadex versus neostigmine.
abstract: BACKGROUND
  Acetylcholinesterase inhibitors cannot rapidly reverse profound neuromuscular block. Sugammadex, a selective relaxant binding agent, reverses the effects of rocuronium and vecuronium by encapsulation. This study assessed the efficacy of sugammadex compared with neostigmine in reversal of profound vecuronium-induced neuromuscular block under sevoflurane anesthesia.
  
  
  METHODS
  Patients aged ≥18 years, American Society of Anesthesiologists class 1-4, scheduled to undergo surgery under general anesthesia were enrolled in this phase III, multicenter, randomized, safety-assessor blinded study. Sevoflurane anesthetized patients received vecuronium 0.1 mg/kg for intubation, with maintenance doses of 0.015 mg/kg as required. Patients were randomized to receive sugammadex 4 mg/kg or neostigmine 70 μg/kg with glycopyrrolate 14 μg/kg at 1-2 post-tetanic counts. The primary efficacy variable was time from start of study drug administration to recovery of the train-of-four ratio to 0.9. Safety assessments included physical examination, laboratory data, vital signs, and adverse events.
  
  
  RESULTS
  Eighty three patients were included in the intent-to-treat population (sugammadex, n = 47; neostigmine, n = 36). Geometric mean time to recovery of the train-of-four ratio to 0.9 was 15-fold faster with sugammadex (4.5 minutes) compared with neostigmine (66.2 minutes; p < 0.0001) (median, 3.3 minutes with sugammadex versus 49.9 minutes with neostigmine). No serious drug-related adverse events occurred in either group.
  
  
  CONCLUSIONS
  Recovery from profound vecuronium-induced block is significantly faster with sugammadex, compared with neostigmine. Neostigmine did not rapidly reverse profound neuromuscular block (Trial registration number: NCT00473694).
authors.affiliation: Stanford University Medical Center, Stanford, CA, USA. hlemmens@stanford.edu.
authors.forename: Hendrikus Jm
authors.initials: HJ
authors.lastname: Lemmens
authors.forename: Mohammad I
authors.initials: MI
authors.lastname: El-Orbany
authors.forename: James
authors.initials: J
authors.lastname: Berry
authors.forename: Jovino Ben
authors.initials: JB
authors.lastname: Morte
authors.forename: Gavin
authors.initials: G
authors.lastname: Martin
references.citation: Can J Anaesth. 2001 Apr;48(4):351-5
references.pmid: 11339776
references.citation: Anesthesiology. 2009 Jul;111(1):30-5
references.pmid: 19512873
references.citation: Anesthesiology. 1990 Sep;73(3):410-4
references.pmid: 1975484
references.citation: Stat Med. 1990 Dec;9(12):1439-45
references.pmid: 2281231
references.citation: Anesth Analg. 2007 Mar;104(3):555-62
references.pmid: 17312208
references.citation: Acta Anaesthesiol Scand. 1996 May;40(5):574-8
references.pmid: 8792887
references.citation: Can J Anaesth. 1999 May;46(5 Pt 1):429-32
references.pmid: 10349921
references.citation: Br J Anaesth. 1995 Jan;74(1):16-9
references.pmid: 7880698
references.citation: Can J Anaesth. 1996 Aug;43(8):799-805
references.pmid: 8840059
references.citation: Anesthesiology. 2003 Jun;98(6):1333-7
references.pmid: 12766640
references.citation: Anesth Analg. 2010 Jan 1;110(1):74-82
references.pmid: 19933538
references.citation: Anesth Analg. 2007 Mar;104(3):575-81
references.pmid: 17312211
references.citation: Drugs. 2001;61(7):919-42
references.pmid: 11434449
references.citation: Acta Anaesthesiol Scand. 2007 Feb;51(2):226-34
references.pmid: 17261149
references.citation: Anesth Analg. 2007 Mar;104(3):563-8
references.pmid: 17312209
references.citation: Anesthesiology. 2008 Nov;109(5):816-24
references.pmid: 18946293