title: The influence of mild hypothermia on reversal of rocuronium-induced deep neuromuscular block with sugammadex.
abstract: BACKGROUND
  Mild hypothermia may be frequently induced due to cool environments in the operating room. The study analyzed patient recovery time and response to sugammadex after a prolonged rocuronium-induced deep neuromuscular block (NMB) during mild hypothermia.
  
  
  METHODS
  Sixty patients were randomly (1:1) allocated to the mild hypothermia and normothermia groups, defined as having core temperatures between 34.5-35°C and 36.5-37°C, respectively. Patients received 0.6 mg/kg of rocuronium, followed by 7-10 μg/kg/min to maintain a deep NMB [post-tetanic count (PTC) 1-2]. After surgery, the deep NMB was reversed with sugammadex 4.0 mg/kg. The primary end-point was the time until the train-of-four (TOF) ratio was 0.9.
  
  
  RESULTS
  The appropriate neuromuscular function (TOF ratio ≥ 0.9) was restored after sugammadex was administered, even after hypothermia. The length of recovery in the hypothermia patients [mean (SD), 171.1 (62.1) seconds (s)] was significantly slower compared with the normothermia patients [124.9 (59.2) s] (p = 0.005). There were no adverse effects from sugammadex.
  
  
  CONCLUSIONS
  Sugammadex safely and securely reversed deep rocuronium-induced NMB during mild hypothermia. An additional 46 s was required for recovery from a deep NMB in hypothermia patients. Based on the results, we think this prolonged recovery time is clinically acceptable.
  
  
  BACKGROUND
  ClinicalTrials.gov Identifier: NCT01965067.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, #17 Haengdang dong, Sungdong gu, Seoul, 133-792, Korea. makeitcool@hanmail.net.
authors.forename: Hee Jong
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, #17 Haengdang dong, Sungdong gu, Seoul, 133-792, Korea. kimks@hanyang.ac.kr.
authors.forename: Kyo Sang
authors.initials: KS
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Samsung Seoul Hospital, Seoul, Korea. wltjs78@hanmail.net.
authors.forename: Ji Seon
authors.initials: JS
authors.lastname: Jeong
authors.affiliation: Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, #17 Haengdang dong, Sungdong gu, Seoul, 133-792, Korea. vesicle100@naver.com.
authors.forename: Kyu Nam
authors.initials: KN
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, #17 Haengdang dong, Sungdong gu, Seoul, 133-792, Korea. awetkiss@naver.com.
authors.forename: Byeong Chan
authors.initials: BC
authors.lastname: Lee
mesh_terms: D000328:Adult; D000732:Androstanols; D000762:Anesthesia Recovery Period; D001794:Blood Pressure / Q000187:drug effects; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007035:Hypothermia / Q000150:complications*; D008297:Male; D008875:Middle Aged; D019148:Neuromuscular Blockade / Q000379:methods*; D003473:Neuromuscular Nondepolarizing Agents; D000077123:Rocuronium; D000077122:Sugammadex; D055815:Young Adult; D047408:gamma-Cyclodextrins / Q000627:therapeutic use*
chemical_list: D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D000077123:Rocuronium