CLINICAL PRACTICE |
Org 25969 (sugammadex), a selective relaxant binding agent for antagonism of prolonged rocuronium-induced neuromuscular block
1 Department of Anaesthetics and Intensive Care Medicine, Queen's University of Belfast, Northern Ireland, UK. 2 Queen's Medical Centre, Nottingham, UK. 3 NV Organon, Oss, The Netherlands
* Corresponding author. Department of Anaesthetics and Intensive Care Medicine, Queen's University of Belfast, Whitla Medical Building, 97 Lisburn Road, Belfast BT9 7BL, Northern Ireland, UK. E-mail: r.mirakhur{at}qub.ac.uk
Background. Org 25969 is a cyclodextrin compound designed to reverse a rocuronium-induced neuromuscular block. The aim of this study was to explore the efficacy, dose–response relation and safety of Org 25969 for reversal of a prolonged rocuronium-induced neuromuscular block.
Methods. Thirty anaesthetized adult patients received rocuronium 0.6 mg kg–1 as an initial dose followed by increments to maintain a deep block at a level of <10 PTCs (post-tetanic counts) recorded every 6 min. Neuromuscular monitoring was carried out using accelerometry, in a train-of-four (TOF) mode using TOF-Watch®SX. At recovery of T2, following at least 2 h of neuromuscular block, patients received their randomly assigned dose of 0.5, 1.0, 2.0, 4.0 or 6.0 mg kg–1 of Org 25969. Anaesthesia and neuromuscular monitoring were continued for a minimum period of 30 min after Org 25969 administration. The main end-point of the study was the time to achieve a sustained recovery of TOF ratio to 0.9. Patients were followed up for 7 days after anaesthesia.
Results. The results showed a dose-related decrease in the average time taken to attain a TOF ratio of 0.9 from 6:49 (min:s) with the 0.5 mg kg–1 dose to 1:22 with the 4.0 mg kg–1 dose. Weighted non-linear regression analysis showed the fastest achievable time to TOF ratio of 0.9 to be 1:35. Org 25969 produced no major adverse effects.
Conclusion. Org 25969 effectively reversed a deep and prolonged neuromuscular block induced by rocuronium. The effective reversal dose appears to be 2–4 mg kg–1.
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