title: Postoperative impairment of motor function at train-of-four ratio ≥0.9 cannot be improved by sugammadex (1 mg kg-1).
abstract: BACKGROUND
  A train-of-four ratio (TOFR) ≥0.9 measured by quantitative neuromuscular monitoring is accepted as an indication of sufficient neuromuscular recovery for extubation, even though many postsynaptic acetylcholine receptors may still be inhibited. We investigated whether antagonism with sugammadex after spontaneous recovery to TOFR≥0.9 further improves muscle function or subjective well-being.
  
  
  METHODS
  Following recovery to TOFR≥0.9 and emergence from anaesthesia, 300 patients randomly received either sugammadex 1.0 mg kg(-1) or placebo. Fine motor function (Purdue Pegboard Test) and maximal voluntary grip strength were measured before and after surgery (before and after test drug administration). At discharge from the postanaesthesia care unit, well-being was assessed with numerical analogue scales and the Quality-of-Recovery Score 40 (QoR-40).
  
  
  RESULTS
  Patients' fine motor function [6 (sd 4) vs 15 (3) pegs (30 s)(-1), P<0.05] and maximal voluntary grip strength (284 (126) vs 386 (125) N, P<0.05) were significantly lower after anaesthesia compared with the pre-anaesthesia baseline. After sugammadex or placebo, motor function was significantly improved in both groups but did not reach the preoperative level. There was no difference between groups at any time. Global well-being was unaffected (QoR-40: placebo, 174 vs 185; sugammadex, 175 vs 186, P>0.05).
  
  
  CONCLUSIONS
  Antagonizing rocuronium at TOF≥0.9 with sugammadex 1.0 mg kg(-) (1) did not improve patients' motor function or well-being when compared with placebo. Our data support the view that TOFR≥0.9 measured by electromyography signifies sufficient recovery of neuromuscular function.
  
  
  BACKGROUND
  The trial is registered at ClinicalTrials.gov (NCT01101139).
authors.affiliation: Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 München, Germany eva.baumueller@lrz.tu-muenchen.de.
authors.forename: E
authors.initials: E
authors.lastname: Baumüller
authors.affiliation: Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 München, Germany.
authors.forename: S J
authors.initials: SJ
authors.lastname: Schaller
authors.affiliation: Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 München, Germany.
authors.forename: Y
authors.initials: Y
authors.lastname: Chiquito Lama
authors.affiliation: Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 München, Germany.
authors.forename: C G
authors.initials: CG
authors.lastname: Frick
authors.affiliation: Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 München, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Bauhofer
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, and Harvard Medical School, 55 Fruit Street, Boston, MA 02115, USA.
authors.forename: M
authors.initials: M
authors.lastname: Eikermann
authors.affiliation: Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 München, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Fink
authors.affiliation: Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 München, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Blobner
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D000732:Androstanols / Q000037:antagonists & inhibitors* / Q000494:pharmacology; D000762:Anesthesia Recovery Period; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D009048:Motor Skills / Q000187:drug effects*; D053580:Muscle Strength / Q000187:drug effects; D061886:Neuromuscular Monitoring / Q000379:methods*; D003473:Neuromuscular Nondepolarizing Agents / Q000037:antagonists & inhibitors* / Q000494:pharmacology; D000077123:Rocuronium; D000077122:Sugammadex; D047408:gamma-Cyclodextrins / Q000494:pharmacology*
chemical_list: D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D000077123:Rocuronium
keywords: neuromuscular blocking agent; postoperative residual paralysis; quantitative neuromuscular monitoring; sugammadex