title: Rapid reversal of neuromuscular blockade by sugammadex after continuous infusion of rocuronium in patients with liver dysfunction undergoing hepatic surgery.
abstract: OBJECTIVE
  Sugammadex rapidly reverses neuromuscular blockade (NMB) induced by rocuronium. NMB induced by rocuronium is prolonged in patients with liver dysfunction, because the drug is mainly excreted into the bile. However, the efficacy and safety of sugammadex in terms of reversing rocuronium-induced NMB in patients with liver dysfunction undergoing hepatic surgery have not been evaluated. This observational study investigated the efficacy and safety of sugammadex after continuous infusion of rocuronium in patients with liver dysfunction undergoing hepatic surgery.
  
  
  METHODS
  Remifentanil/propofol anesthesia was administered to 31 patients: 15 patients in the control group, and 16 patients from a group with liver dysfunction. Rocuronium (0.6 mg/kg) was administered, followed by continuous infusion. The enrolled patients were then subdivided into two groups according to the dose of sugammadex. In the first group a single dose of sugammadex (2.0 mg/kg) was given at the reappearance of the second twitch (T2). In the second group a single dose of sugammadex (4.0 mg/kg) was given at the first twitch response if T2 did not reappear in 15 minutes after stopping rocuronium. The primary outcome was time from administration of sugammadex to recovery of a train-of-four ratio to 0.9.
  
  
  RESULTS
  The dose of rocuronium required in the liver dysfunction group was lower than that in the control group (6.2 vs. 8.2 μg/kg/min, p = 0.002). The mean time from the administration of sugammadex to recovery of the train-of-four ratio to 0.9 was not significantly different between the liver dysfunction group and the control group (2.2 minutes vs. 2.0 minutes in the 2 mg/kg administration group, p = 0.44 and 1.9 minutes vs. 1.7 minutes in the 4 mg/kg administration group, p = 0.70, respectively). No evidence of recurarization was observed in any of the patients. Most of the adverse events were found to be mild and such events were not related to the use of sugammadex. None of the patients was eliminated from the study because of an adverse event. One patient died due to cholestatic liver cirrhosis because of repeated hepatic surgery.
  
  
  CONCLUSIONS
  Sugammadex can rapidly reverse NMB after continuous infusion of rocuronium in patients with liver dysfunction undergoing hepatic surgery. Sugammadex was found to be safe and well tolerated. However, further studies of sugammadex under similar conditions should be conducted involving a large number of patients with liver dysfunction undergoing hepatic surgery.
authors.affiliation: Department of Clinical Pharmacology, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, Fukuoka, Japan. Electronic address: ai-fuji823@hotmail.co.jp.
authors.forename: Ai
authors.initials: A
authors.lastname: Fujita
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, Fukuoka, Japan.
authors.forename: Natsuki
authors.initials: N
authors.lastname: Ishibe
authors.affiliation: Department of Clinical Pharmacology, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Yoshihara
authors.affiliation: Doctoral Program in Life System Medical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Ohashi
authors.affiliation: Shiraishi Hospital Diabetes Center, Imabari, Ehime, Japan.
authors.forename: Hideichi
authors.initials: H
authors.lastname: Makino
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, Fukuoka, Japan.
authors.forename: Mizuko
authors.initials: M
authors.lastname: Ikeda
authors.affiliation: Department of Anesthesiology, Kyushu Medical Center, Fukuoka, Japan.
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Setoguchi
mesh_terms: D000368:Aged; D000732:Androstanols / Q000037:antagonists & inhibitors*; D005260:Female; D006801:Humans; D008099:Liver / Q000601:surgery*; D008107:Liver Diseases / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009466:Neuromuscular Blocking Agents / Q000037:antagonists & inhibitors*; D000077123:Rocuronium; D000077122:Sugammadex; D047408:gamma-Cyclodextrins / Q000494:pharmacology*
chemical_list: D000732:Androstanols; D009466:Neuromuscular Blocking Agents; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D000077123:Rocuronium
keywords: digestive system surgical procedures: hepatic; gamma-Cyclodextrins: sugammadex; liver diseases; neuromuscular blockade; neuromuscular nondepolarizing agents: rocuronium