title: Reversal of rocuronium induced neuromuscular block with sugammadex or neostigmine: a large observational study.
abstract: BACKGROUND
  This 'real-life' study aimed to analyze the time from the start of neostigmine or sugammadex administration to recovery to a train of four ratio (TOFr) of 0.9 in a real-life in patients receiving rocuronium. The secondary aims were to assess the proportion of patients: presenting TOFr < 0.9 after 5, 10, and 20 min from reversal agent administration, receiving opioids for intraoperative analgesia and extubated in the post-anesthesia care unit (PACU).
  
  
  METHODS
  This was a multisite, prospective, nonrandomized, observational real-life study. Reversal agent was administered at either T2 reappearance or at a post-tetanic count of 1 or 2. Drugs dosages were free according to each investigator's usual practice.
  
  
  RESULTS
  Three hundred fifty-nine patients were enrolled onto the study. Time from reversal administration to TOFr to 0.9 is significantly faster in the sugammadex group than in the neostigmine group (shallow block: 2.2 vs. 6.9 min, respectively; P < 0.0001; deep block: 2.7 vs. 16.2 min, respectively; P < 0.0001). The number of patients with TOFr < 0.9 at 5, 10, and 20 min post-reversal agent administration was higher in the neostigmine than in the sugammadex group. Just five patients did not receive opioids. All patients were extubated in the operative room except for a single patient in the sugammadex group who was extubated following PACU admission.
  
  
  CONCLUSIONS
  This real-life study confirms that reversal time is faster in patients receiving sugammadex than in those receiving neostigmine. TOFr < 0.9 20 min after reversal was only present in patients treated with neostigmine.
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, AOU Santa Maria della Misericordia - University of Udine, Udine, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Della Rocca
authors.forename: L
authors.initials: L
authors.lastname: Pompei
authors.forename: C
authors.initials: C
authors.lastname: Pagan DE Paganis
authors.forename: S
authors.initials: S
authors.lastname: Tesoro
authors.forename: C
authors.initials: C
authors.lastname: Mendola
authors.forename: P
authors.initials: P
authors.lastname: Boninsegni
authors.forename: A
authors.initials: A
authors.lastname: Tempia
authors.forename: S
authors.initials: S
authors.lastname: Manstretta
authors.forename: L
authors.initials: L
authors.lastname: Zamidei
authors.forename: A
authors.initials: A
authors.lastname: Gratarola
authors.forename: P
authors.initials: P
authors.lastname: Murabito
authors.forename: L
authors.initials: L
authors.lastname: Fuggiano
authors.forename: P
authors.initials: P
authors.lastname: DI Marco
mesh_terms: D000005:Abdomen / Q000601:surgery; D000328:Adult; D000368:Aged; D060666:Airway Extubation; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000732:Androstanols / Q000037:antagonists & inhibitors*; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000187:drug effects; D009388:Neostigmine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D019148:Neuromuscular Blockade; D003473:Neuromuscular Nondepolarizing Agents / Q000037:antagonists & inhibitors*; D010277:Parasympathomimetics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D011997:Recovery Room; D000077123:Rocuronium; D018401:Sample Size; D000077122:Sugammadex; D047408:gamma-Cyclodextrins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000701:Analgesics, Opioid; D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D010277:Parasympathomimetics; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D009388:Neostigmine; D000077123:Rocuronium