title: Reversal of rocuronium-induced neuromuscular block by sugammadex is independent of renal perfusion in anesthetized cats.
abstract: OBJECTIVE
  Sugammadex is a selective relaxant binding agent designed to encapsulate the aminosteroidal neuromuscular blocking agent rocuronium, thereby reversing its effect. Both sugammadex and the sugammadex-rocuronium complex are eliminated by the kidneys. This study investigated the effect of sugammadex on recovery of rocuronium-induced neuromuscular block in cats with clamped renal pedicles, as a model for acute renal failure.
  
  
  METHODS
  Twelve male cats were divided into two groups and anesthetized with medetomidine, ketamine, and alpha-chloralose. The cats were intubated and ventilated with a mixture of oxygen and air. Neuromuscular monitoring was performed by single twitch monitoring. Rocuronium 0.5 mg/kg i.v. was administered. After spontaneous recovery from neuromuscular block, both renal pedicles were ligated. A second dose of rocuronium 0.5 mg/kg i.v. was given. One minute after disappearance of the twitches, in Group 1 placebo (0.9% saline) and in Group 2 sugammadex 5.0 mg/kg i.v. was administered. Onset time, duration of neuromuscular block, and time to recovery to 25, 50, 75, and 90% were determined.
  
  
  RESULTS
  After renal pedicle ligation, sugammadex reversed rocuronium-induced neuromuscular block significantly faster than spontaneous recovery. Mean time (SEM) to 90% recovery of the twitch response was 4.7 (0.25) min (Group 2) versus 31.1 (5.0) min (Group 1) (p < 0.0001). No signs of recurrence of neuromuscular block were observed for 90 min after complete twitch restoration. Sugammadex caused no significant cardiovascular effects.
  
  
  CONCLUSIONS
  Sugammadex rapidly and effectively reversed rocuronium-induced neuromuscular block in anesthetized cats, even when both renal pedicles were ligated and renal elimination of the drugs was no longer possible.
authors.affiliation: Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. L.Staals@erasmusmc.nl
authors.forename: Lonneke M
authors.initials: LM
authors.lastname: Staals
authors.forename: Hans D
authors.initials: HD
authors.lastname: de Boer
authors.forename: Jan
authors.initials: J
authors.lastname: van Egmond
authors.forename: Frank
authors.initials: F
authors.lastname: Hope
authors.forename: Francien
authors.initials: F
authors.lastname: van de Pol
authors.forename: Anton H
authors.initials: AH
authors.lastname: Bom
authors.forename: Jacques J
authors.initials: JJ
authors.lastname: Driessen
authors.forename: Leo H D J
authors.initials: LH
authors.lastname: Booij
mesh_terms: D000732:Androstanols / Q000494:pharmacology*; D000818:Animals; D002415:Cats; D006339:Heart Rate / Q000187:drug effects; D008297:Male; D019148:Neuromuscular Blockade; D003473:Neuromuscular Nondepolarizing Agents / Q000494:pharmacology*; D012079:Renal Circulation; D000077123:Rocuronium; D000077122:Sugammadex; D047408:gamma-Cyclodextrins / Q000494:pharmacology*
chemical_list: D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D000077123:Rocuronium