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Reversal of rocuronium induced neuromuscular block with sugammadex or neostigmine: a large observational study
Author(s) -
DELLA ROCCA G.,
POMPEI L.,
PAGAN DE PAGANIS C.,
TESORO S.,
MENDOLA C.,
BONINSEGNI P.,
TEMPIA A.,
MANSTRETTA S.,
ZAMIDEI L.,
GRATAROLA A.,
MURABITO P.,
FUGGIANO L.,
DI MARCO P.
Publication year - 2013
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.12155
Subject(s) - sugammadex , medicine , neostigmine , rocuronium , anesthesia , pacu , observational study , neuromuscular monitoring , prospective cohort study , surgery , neuromuscular blockade , propofol
Background This ‘real‐life’ study aimed to analyze the time from the start of neostigmine or sugammadex administration to recovery to a train of four ratio ( TOFr ) of 0.9 in a real‐life in patients receiving rocuronium. The secondary aims were to assess the proportion of patients: presenting TOFr < 0.9 after 5, 10, and 20 min from reversal agent administration, receiving opioids for intraoperative analgesia and extubated in the post‐anesthesia care unit ( PACU ). Methods This was a multisite, prospective, nonrandomized, observational real‐life study. Reversal agent was administered at either T 2 reappearance or at a post‐tetanic count of 1 or 2. Drugs dosages were free according to each investigator's usual practice. Results Three hundred fifty‐nine patients were enrolled onto the study. Time from reversal administration to TOFr to 0.9 is significantly faster in the sugammadex group than in the neostigmine group (shallow block: 2.2 vs. 6.9 min, respectively; P < 0.0001; deep block: 2.7 vs. 16.2 min, respectively; P < 0.0001). The number of patients with TOFr < 0.9 at 5, 10, and 20 min post‐reversal agent administration was higher in the neostigmine than in the sugammadex group. Just five patients did not receive opioids. All patients were extubated in the operative room except for a single patient in the sugammadex group who was extubated following PACU admission. Conclusions This real‐life study confirms that reversal time is faster in patients receiving sugammadex than in those receiving neostigmine. TOFr < 0.9 20 min after reversal was only present in patients treated with neostigmine.