BJA Advance Access originally published online on April 2, 2008
British Journal of Anaesthesia 2008 100(5):622-630; doi:10.1093/bja/aen037
Reversal of rocuronium-induced neuromuscular block with sugammadex is faster than reversal of cisatracurium-induced block with neostigmine
1 University Department of Anaesthesia, School of Clinical Sciences, Duncan Building, Daulby Street, Liverpool L69 3GA, UK
2 Department of Anaesthesia, University Federico II, Napoli, Italy
3 Hospital Clinico y Provincial de Barcelona, Barcelona, Spain
4 Queens University Belfast, Belfast, Northern Ireland
5 Hospital de Basurto, Bilbao, Spain
6 Ospedala Santa Chiara Pisa, Pisa, Italy
7 Hôpital Brabois, Vandoeuvre les Nancy, France
8 NV Organon, a part of Schering-Plough Corporation, Oss, The Netherlands
* Corresponding author. E-mail: lizzy{at}lizzyflockton.fsnet.co.uk
Background: Reversal of the residual effect of rocuronium or cisatracurium by neostigmine may be slow and associated with side-effects. This randomized, safety-assessor-blinded study compared the efficacy of sugammadex, a selective relaxant binding agent for reversal of rocuronium-induced neuromuscular block, with that of neostigmine for reversal of cisatracurium-induced neuromuscular block. The safety of sugammadex and neostigmine was also evaluated.
Methods: Adult surgical patients (ASA class I–III) were randomized to sugammadex 2.0 mg kg–1 for reversal of block induced by rocuronium 0.6 mg kg–1, or neostigmine 50 µg kg–1 for reversal of block induced by cisatracurium 0.15 mg kg–1. Anaesthesia was induced and maintained using i.v. propofol and remifentanil, fentanyl, or sufentanil. Neuromuscular function was monitored using acceleromyography (TOF-Watch® SX). Sugammadex or neostigmine was administered at reappearance of T2. The primary efficacy variable was time for recovery of the train-of-four (TOF) ratio to 0.9.
Results: Eighty-four patients were randomized, 73 of whom received sugammadex (n=34) or neostigmine (n=39). Time from start of administration of reversal agent to recovery of the TOF ratio to 0.9 was 4.7 times faster with sugammadex than with neostigmine (geometric mean=1.9 vs 9.0 min, P<0.0001). Reversal of block was sustained in all patients. There were no serious adverse effects from either reversal agent and no significant changes in any measure of safety, except for similar elevations in urinary N-acetyl glucosaminidase in both groups.
Conclusions: Sugammadex 2.0 mg kg–1 administered at reappearance of T2 was significantly faster in reversing rocuronium-induced blockade than neostigmine was in reversing cisatracurium-induced block.
Keywords: antagonists neuromuscular block, cyclodextrins, sugammadex; antagonists neuromuscular block, neostigmine; monitoring, neuromuscular block; neuromuscular block, rocuronium, cisatracurium; pharmacodynamics
Declaration of interest: M.E.P. is an employee of N.V. Organon, a part of Schering-Plough Corporation, Oss, The Netherlands. R.K.M. is a member of the Scientific Advisory Board of N.V. Organon, a part of Schering-Plough Corporation.