Advanced

Sugammadex rapidly reverses moderate rocuronium- or vecuronium-induced neuromuscular block during sevoflurane anaesthesia: a dose-response relationship

Puehringer, F. K.; Gordon, M.; Demeyer, I.; Sparr, H. J.; Ingimarsson, Jonas LU ; Klarin, Bengt LU ; van Duijnhoven, W. and Heeringa, M. (2010) In British Journal of Anaesthesia 105(5). p.610-619
Abstract
Sugammadex shows a dose-response relationship for reversal of neuromuscular block (NMB) during propofol anaesthesia. Sevoflurane, unlike propofol, can prolong the effect of neuromuscular blocking agents (NMBAs), increasing recovery time. This open-label, randomized, dose-finding trial explored sugammadex dose-response relationships, safety, and pharmacokinetics when administered for reversal of moderate rocuronium- or vecuronium-induced NMB during sevoflurane maintenance anaesthesia. After anaesthesia induction with propofol, adult patients were randomized to receive single-dose rocuronium 0.9 mg kg(-1) or vecuronium 0.1 mg kg(-1), with maintenance doses as needed. Anaesthesia was maintained with sevoflurane. NMB was monitored using... (More)
Sugammadex shows a dose-response relationship for reversal of neuromuscular block (NMB) during propofol anaesthesia. Sevoflurane, unlike propofol, can prolong the effect of neuromuscular blocking agents (NMBAs), increasing recovery time. This open-label, randomized, dose-finding trial explored sugammadex dose-response relationships, safety, and pharmacokinetics when administered for reversal of moderate rocuronium- or vecuronium-induced NMB during sevoflurane maintenance anaesthesia. After anaesthesia induction with propofol, adult patients were randomized to receive single-dose rocuronium 0.9 mg kg(-1) or vecuronium 0.1 mg kg(-1), with maintenance doses as needed. Anaesthesia was maintained with sevoflurane. NMB was monitored using acceleromyography. After the last dose of NMBA, at reappearance of T-2, single-dose sugammadex 0.5, 1.0, 2.0, or 4.0 mg kg(-1) or placebo was administered. The primary efficacy variable was time from the start of sugammadex administration to recovery of T-4/T-1 ratio to 0.9. Safety assessments were performed throughout. The per-protocol population comprised 93 patients (rocuronium, n=46; vecuronium, n=47). A statistically significant dose-response relationship was demonstrated for mean recovery times of T-4/T-1 ratio to 0.9 with increasing sugammadex dose with both NMBAs: rocuronium, 96.3 min (placebo) to 1.5 min (sugammadex 4.0 mg kg(-1)); vecuronium, 79.0 min (placebo) to 3.0 min (sugammadex 4.0 mg kg(-1)). Plasma sugammadex concentrations indicated linear pharmacokinetics, independent of NMBA administered. No study drug-related serious adverse events occurred. Evidence of reoccurrence of block was reported in seven patients [sugammadex 0.5 mg kg(-1) (suboptimal dose), n=6; 2.0 mg kg(-1), n=1]. During sevoflurane maintenance anaesthesia, sugammadex provides well-tolerated, effective, dose-dependent reversal of moderate rocuronium- and vecuronium-induced NMB. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
vecuronium, sugammadex, sevoflurane, reversal, rocuronium
in
British Journal of Anaesthesia
volume
105
issue
5
pages
610 - 619
publisher
Macmillan
external identifiers
  • wos:000283119200009
  • scopus:77958173062
ISSN
1471-6771
DOI
10.1093/bja/aeq226
language
English
LU publication?
yes
id
56d64ac5-ff15-4f83-9e1f-0831e93bb89e (old id 1721036)
date added to LUP
2010-12-03 12:49:48
date last changed
2018-05-29 10:21:34
@article{56d64ac5-ff15-4f83-9e1f-0831e93bb89e,
  abstract     = {Sugammadex shows a dose-response relationship for reversal of neuromuscular block (NMB) during propofol anaesthesia. Sevoflurane, unlike propofol, can prolong the effect of neuromuscular blocking agents (NMBAs), increasing recovery time. This open-label, randomized, dose-finding trial explored sugammadex dose-response relationships, safety, and pharmacokinetics when administered for reversal of moderate rocuronium- or vecuronium-induced NMB during sevoflurane maintenance anaesthesia. After anaesthesia induction with propofol, adult patients were randomized to receive single-dose rocuronium 0.9 mg kg(-1) or vecuronium 0.1 mg kg(-1), with maintenance doses as needed. Anaesthesia was maintained with sevoflurane. NMB was monitored using acceleromyography. After the last dose of NMBA, at reappearance of T-2, single-dose sugammadex 0.5, 1.0, 2.0, or 4.0 mg kg(-1) or placebo was administered. The primary efficacy variable was time from the start of sugammadex administration to recovery of T-4/T-1 ratio to 0.9. Safety assessments were performed throughout. The per-protocol population comprised 93 patients (rocuronium, n=46; vecuronium, n=47). A statistically significant dose-response relationship was demonstrated for mean recovery times of T-4/T-1 ratio to 0.9 with increasing sugammadex dose with both NMBAs: rocuronium, 96.3 min (placebo) to 1.5 min (sugammadex 4.0 mg kg(-1)); vecuronium, 79.0 min (placebo) to 3.0 min (sugammadex 4.0 mg kg(-1)). Plasma sugammadex concentrations indicated linear pharmacokinetics, independent of NMBA administered. No study drug-related serious adverse events occurred. Evidence of reoccurrence of block was reported in seven patients [sugammadex 0.5 mg kg(-1) (suboptimal dose), n=6; 2.0 mg kg(-1), n=1]. During sevoflurane maintenance anaesthesia, sugammadex provides well-tolerated, effective, dose-dependent reversal of moderate rocuronium- and vecuronium-induced NMB.},
  author       = {Puehringer, F. K. and Gordon, M. and Demeyer, I. and Sparr, H. J. and Ingimarsson, Jonas and Klarin, Bengt and van Duijnhoven, W. and Heeringa, M.},
  issn         = {1471-6771},
  keyword      = {vecuronium,sugammadex,sevoflurane,reversal,rocuronium},
  language     = {eng},
  number       = {5},
  pages        = {610--619},
  publisher    = {Macmillan},
  series       = {British Journal of Anaesthesia},
  title        = {Sugammadex rapidly reverses moderate rocuronium- or vecuronium-induced neuromuscular block during sevoflurane anaesthesia: a dose-response relationship},
  url          = {http://dx.doi.org/10.1093/bja/aeq226},
  volume       = {105},
  year         = {2010},
}