Relationship between first-twitch depression and train-of-four ratio during sugammadex reversal of rocuronium-induced neuromuscular blockade.
BACKGROUND
The primary outcome of sugammadex reversal for rocuronium-induced neuromuscular block (NMB) is a train-of-four ratio (TOFR) of 0.9, not first twitch (T1) height. We investigated whether the recovery of TOFR or T1 differs based on the reversal of NMB with neostigmine or sugammadex.


METHODS
The acceleromyographic responses from 0.6 mg/kg of rocuronium were monitored supramaximally in 80 patients after induction of anesthesia. The TOFR and T1 height were recorded, and saved in a personal computer using TOF-Watch SX Monitor software in all patients. Patients were randomly assigned to 2 groups to receive either neostigmine 50 µg/kg with glycopyrrolate 10 µg/kg (neostigmine group, n = 40) or sugammadex 2.0 mg/kg (sugammadex group, n = 40). The primary objective was to determine the difference of recovery time between TOFR to 0.9 and T1 to 0.9 after sugammadex or neostigmine administration during moderate rocuronium-induced NMB.


RESULTS
The recovery pattern of the TOFR 2 min after sugammadex administration was 1.0 or more, but that of T1 was less than 90% (T1 / control value) up to 6 min after drug was injected. The recovery pattern of TOFR and T1 was similar during the 20 min after reversal with neostigmine.


CONCLUSIONS
If you have not performed the T1 monitoring, both TOFR and T1 should be considered to confirm suitable recovery during the 6 min after reversal with sugammadex during rocuronium-induced moderate NMB.
Department of Anesthesiology and Pain Medicine, Hanyang University College of Medicine, Seoul, Korea.
Kyo Sang
0000-0002-2186-3484
KS
Kim
Department of Anesthesiology and Pain Medicine, Hanyang University College of Medicine, Seoul, Korea.
You Na
YN
Oh
Department of Anesthesiology and Pain Medicine, Hanyang University College of Medicine, Seoul, Korea.
Tae Yeon
TY
Kim
Department of Anesthesiology and Pain Medicine, Hanyang University College of Medicine, Seoul, Korea.
Song Yee
SY
Oh
Department of Anesthesiology and Pain Medicine, Hanyang University College of Medicine, Seoul, Korea.
Yeong Hun
YH
Sin
Neostigmine; Neuromuscular monitoring; Rocuronium; Sugammadex