title: Sugammadex at both high and low doses does not affect the depth of anesthesia or hemodynamics: a randomized double blind trial.
abstract: Previous studies have shown that sugammadex decreases the anesthetic depth when administered to reverse the neuromuscular blockade produced by rocuronium/vecuronium. The aim of the present study was to investigate the effect of sugammadex alone on anesthetic depth and hemodynamics. Sixty patients scheduled for abdominal surgery participated in the study. Anesthesia was induced with thiopental/fentanyl and maintained with N2O/oxygen and sevoflurane concentrations adjusted to maintain Entropy and Bispectral Index (BIS) values between 40 and 50. Cis-atracurium 0.2 mg/kg was administered for neuromuscular blockade which was monitored with a TOF-Watch®SX acceleromyograph. State entropy (SE), response entropy (RE), Bispectral Index (BIS), systolic (SAP) and diastolic blood pressure (DAP), heart rate (HR), SpO2, end-tidal CO2and sevoflurane concentrations were recorded every 3 min intraoperatively. Sugammadex 2 mg/kg (Group-2), 4 mg/kg (Group-4) or 16 mg/kg (Group-16) was given intravenously when a count of two responses of the train-of-four (TOF) or a post-tetanic count (PTC) 1-3 appeared or when no response at all (PTC = 0) was observed, respectively. The overall SE values, thus the primary outcome of the study, were 44 ± 11, 43 ± 10 and 43 ± 11 for Group-2, Group-4 and Group-16, respectively (p = 0.812). Also, the secondary endpoints, namely RE, BIS, SAP and DAP, HR and SpO2did not differ between the three groups. Comparisons between Group-2 versus Group-4, Group-2 versus Group-16 and Group-4 versus Group-16 showed no differences (p > 0.05) for all the studied variables. Sugammadex alone at low, medium or high clinical doses has no effect on anesthetic depth as assessed by Entropy and BIS or on hemodynamics.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Aretaieio University Hospital, 76 Vassilissis Sofias Ave, 11528, Athens, Greece. fassoula@aretaieio.uoa.gr.
authors.forename: Argyro
authors.initials: A
authors.lastname: Fassoulaki
authors.affiliation: Department of Anesthesiology and Pain Medicine, Aretaieio University Hospital, 76 Vassilissis Sofias Ave, 11528, Athens, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Chondrogiannis
authors.affiliation: Department of Anesthesiology and Pain Medicine, Aretaieio University Hospital, 76 Vassilissis Sofias Ave, 11528, Athens, Greece.
authors.forename: Chryssoula
authors.initials: C
authors.lastname: Staikou
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000732:Androstanols / Q000008:administration & dosage; D000758:Anesthesia / Q000379:methods*; D000762:Anesthesia Recovery Period; D001279:Atracurium / Q000008:administration & dosage; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004562:Electrocardiography; D019277:Entropy; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D019148:Neuromuscular Blockade; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage*; D010100:Oxygen / Q000737:chemistry; D000077123:Rocuronium; D000077149:Sevoflurane; D000077122:Sugammadex; D014673:Vecuronium Bromide / Q000008:administration & dosage; D047408:gamma-Cyclodextrins / Q000008:administration & dosage*
chemical_list: D000732:Androstanols; D008738:Methyl Ethers; D003473:Neuromuscular Nondepolarizing Agents; D047408:gamma-Cyclodextrins; D001279:Atracurium; D000077122:Sugammadex; D000077149:Sevoflurane; D014673:Vecuronium Bromide; D010100:Oxygen; D000077123:Rocuronium
keywords: Anesthesia; Bispectral Index; Depth; Entropy; Hemodynamics; Sugammadex