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The influence of mild hypothermia on reversal of rocuronium-induced deep neuromuscular block with sugammadex.

ABSTRACT: Mild hypothermia may be frequently induced due to cool environments in the operating room. The study analyzed patient recovery time and response to sugammadex after a prolonged rocuronium-induced deep neuromuscular block (NMB) during mild hypothermia.Sixty patients were randomly (1:1) allocated to the mild hypothermia and normothermia groups, defined as having core temperatures between 34.5-35°C and 36.5-37°C, respectively. Patients received 0.6 mg/kg of rocuronium, followed by 7-10 ?g/kg/min to maintain a deep NMB [post-tetanic count (PTC) 1-2]. After surgery, the deep NMB was reversed with sugammadex 4.0 mg/kg. The primary end-point was the time until the train-of-four (TOF) ratio was 0.9.The appropriate neuromuscular function (TOF ratio???0.9) was restored after sugammadex was administered, even after hypothermia. The length of recovery in the hypothermia patients [mean (SD), 171.1 (62.1) seconds (s)] was significantly slower compared with the normothermia patients [124.9 (59.2) s] (p?=?0.005). There were no adverse effects from sugammadex.Sugammadex safely and securely reversed deep rocuronium-induced NMB during mild hypothermia. An additional 46 s was required for recovery from a deep NMB in hypothermia patients. Based on the results, we think this prolonged recovery time is clinically acceptable.ClinicalTrials.gov Identifier: NCT01965067.

SUBMITTER: Lee HJ

PROVIDER: S-EPMC4430027 | biostudies-literature | 2015 Jan

REPOSITORIES: biostudies-literature

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The influence of mild hypothermia on reversal of rocuronium-induced deep neuromuscular block with sugammadex.

Lee Hee Jong HJ Kim Kyo Sang KS Jeong Ji Seon JS Kim Kyu Nam KN Lee Byeong Chan BC

BMC anesthesiology 20150121

<h4>Background</h4>Mild hypothermia may be frequently induced due to cool environments in the operating room. The study analyzed patient recovery time and response to sugammadex after a prolonged rocuronium-induced deep neuromuscular block (NMB) during mild hypothermia.<h4>Methods</h4>Sixty patients were randomly (1:1) allocated to the mild hypothermia and normothermia groups, defined as having core temperatures between 34.5-35°C and 36.5-37°C, respectively. Patients received 0.6 mg/kg of rocuro ...[more]

PMID: 25971394

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Project description:Background and Objectives: Sugammadex is widely used in anesthesia to reverse rocuronium-induced neuromuscular blockade (NMB). In patients with compromised kidney function, most drugs show alteration of their pharmacokinetic profile with reduced clearance. The purpose of this article is to examine the efficacy, pharmacokinetics, and safety of sugammadex in end-stage renal disease (ESRD) patients receiving general anesthesia, using a systematic review. Materials and Methods: The databases of PubMed, EMBASE, the Cochrane Library, Web of Science, Scopus, KoreaMed, and ClinicalTrials.gov were searched for studies comparing the efficacy or safety outcomes of sugammadex administration for the reversal of rocuronium-induced NMB, in ESRD patients (group R) or in those with normal renal function (group N) undergoing surgery under general anesthesia. Results: We identified nine studies with 655 patients-six prospective, case-control studies with 179 patients (89 and 90 in groups R and N) and three retrospective observational studies with 476 ESRD patients. In the six prospective studies, the times taken to reach a train-of-four ratio ≥0.9, 0.8, and 0.7 were significantly longer in group R than in group N (weighted mean difference [95% confidence interval] [min]: 1.14 [0.29 to 2.00], 0.9 [0.24 to 1.57], 0.89 [0.20 to 1.57], respectively). The total plasma clearance of sugammadex was significantly lower in group R than in group N. There was no significant difference in the incidence of NMB recurrence and prolonged time to recovery between the groups. In the three retrospective studies, the possibility of sugammadex-related adverse events appears to be insignificant. Conclusions: Sugammadex may effectively and safely reverse rocuronium-induced NMB in patients with ESRD, although the recovery to a TOF ratio of 0.9 may be prolonged compared to patients with normal renal function. Further studies are needed, considering the small number of studies included and the high heterogeneity of some of the results.

Dataset Information

The influence of mild hypothermia on reversal of rocuronium-induced deep neuromuscular block with sugammadex.

Publications

The influence of mild hypothermia on reversal of rocuronium-induced deep neuromuscular block with sugammadex.

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