title: Diaphragmatic and intercostal electromyographic activity during neostigmine, sugammadex and neostigmine-sugammadex-enhanced recovery after neuromuscular blockade: A randomised controlled volunteer study.
abstract: Electromyographic activity of the diaphragm (EMGdi) during weaning from mechanical ventilation is increased after sugammadex compared with neostigmine.
  
  
  
  To determine the effect of neostigmine on EMGdi and surface EMG (sEMG) of the intercostal muscles during antagonism of rocuronium block with neostigmine, sugammadex and neostigmine followed by sugammadex.
  
  
  
  Randomised, controlled, double-blind study.
  
  
  
  Intensive care research unit.
  
  
  
  Eighteen male volunteers.
  
  
  
  A transoesophageal EMGdi recorder was inserted into three groups of six anaesthetised study participants, and sEMG was recorded on their intercostal muscles. To reverse rocuronium, volunteers received 50 μg kg neostigmine, 2 mg kg sugammadex or 50 μg kg neostigmine, followed 3 min later by 2 mg kg sugammadex.
  
  
  
  We examined the EMGdi and sEMG at the intercostal muscles during recovery enhanced by neostigmine or sugammadex or neostigmine-sugammadex as primary outcomes. Secondary objectives were the tidal volume, PaO2 recorded between the onset of spontaneous breathing and extubation of the trachea and SpO2 during and after anaesthesia.
  
  
  
  During weaning, median peak EMGdi was 0.76 (95% confidence interval: 1.20 to 1.80) μV in the neostigmine group, 1.00 (1.23 to 1.82) μV in the sugammadex group and 0.70 (0.91 to 1.21) μV in the neostigmine-sugammadex group (P < 0.0001 with EMGdi increased after sugammadex vs. neostigmine and neostigmine-sugammadex). The median peak intercostal sEMG for the neostigmine group was 0.39 (0.65 to 0.93) μV vs. 0.77 (1.15 to 1.51) μV in the sugammadex group and 0.82 (1.28 to 2.38) μV in the neostigmine-sugammadex group (P < 0.0001 with sEMG higher after sugammadex and after neostigmine-sugammadex vs. neostigmine).
  
  
  
  EMGdi and sEMG on the intercostal muscles were increased after sugammadex alone compared with neostigmine. Adding sugammadex after neostigmine reduced the EMGdi compared with sugammadex alone. Unlike the diaphragm, intercostal EMG was preserved with neostigmine followed by sugammadex.
  
  
  
  EudraCT: 2015-001278-16; ClinicalTrials.gov: NCT02403063.
authors.affiliation: From the Department of Anaesthesiology and Critical Care Medicine, Onze-Lieve-Vrouw Ziekenhuis, Aalst (GC, NDN, LF); Department of Anaesthesiology, (TS, DW); Department of Critical Care Medicine, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium (PGJ).
authors.forename: Guy
authors.initials: G
authors.lastname: Cammu
authors.forename: Tom
authors.initials: T
authors.lastname: Schepens
authors.forename: Nikolaas
authors.initials: N
authors.lastname: De Neve
authors.forename: Davina
authors.initials: D
authors.lastname: Wildemeersch
authors.forename: Luc
authors.initials: L
authors.lastname: Foubert
authors.forename: Philippe G
authors.initials: PG
authors.lastname: Jorens
mesh_terms: D000328:Adult; D060666:Airway Extubation / Q000706:statistics & numerical data; D000732:Androstanols / Q000009:adverse effects; D000762:Anesthesia Recovery Period; D002800:Cholinesterase Inhibitors / Q000008:administration & dosage*; D003964:Diaphragm / Q000294:innervation / Q000502:physiology*; D004311:Double-Blind Method; D004576:Electromyography; D064368:Healthy Volunteers; D006801:Humans; D007366:Intercostal Muscles / Q000294:innervation / Q000502:physiology*; D007367:Intercostal Nerves / Q000187:drug effects; D008297:Male; D009388:Neostigmine / Q000008:administration & dosage; D019148:Neuromuscular Blockade / Q000009:adverse effects* / Q000379:methods; D003473:Neuromuscular Nondepolarizing Agents / Q000009:adverse effects*; D000077123:Rocuronium; D000077122:Sugammadex; D013997:Time Factors; D055815:Young Adult; D047408:gamma-Cyclodextrins / Q000008:administration & dosage
chemical_list: D000732:Androstanols; D002800:Cholinesterase Inhibitors; D003473:Neuromuscular Nondepolarizing Agents; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D009388:Neostigmine; D000077123:Rocuronium