BJA Advance Access originally published online on October 3, 2006
British Journal of Anaesthesia 2006 97(5):681-686; doi:10.1093/bja/ael240
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Time course of action of sugammadex (Org 25969) on rocuronium-induced block in the Rhesus monkey, using a simple model of equilibration of complex formation
1 Department of Anaesthesiology, Radboud University Medical Centre Nijmegen The Netherlands
2 Department of Pharmacology Organon Newhouse, ML1 5SH, Scotland, UK
*Corresponding author: Department of Anaesthesiology, Martini Hospital Groningen, PO Box 30033, 9700 RM Groningen, The Netherlands. E-mail: HD.de.Boer{at}mzh.nl
Background. Reversal of neuromuscular block can be accomplished by chemical encapsulation of rocuronium by sugammadex (Org 25969), a synthetic 
-cyclodextrin derivative. The present study determined the time course of the reversal action of sugammadex on rocuronium-induced block in the anaesthetized Rhesus monkey using train-of-four stimulation.
Methods. A bolus injection of rocuronium 100 µg kg–1 (about 1xED90) was given to determine the degree of neuromuscular block reached by this dose. After complete spontaneous recovery, a rapid bolus injection of sugammadex, 1 mg kg–1, was given and at different time intervals (15, 30 or 60 min, in three different experiments) the effect of another rocuronium bolus injection of 100 µg kg–1 was determined.
Results. Injection of the first dose of rocuronium resulted in a mean neuromuscular block (depression of first twitch) of 93 (SEM=1.6)%. Fifteen minutes after injection of sugammadex the same rocuronium dose resulted in 17% (SEM=5.6) block. After 30 and 60 min these maximum blocks amounted to 49% (SEM=7.6) and 79% (SEM=4.2), respectively. The estimated half-life of sugammadex in Rhesus monkey is 30 (SEM=4.9) min.
Conclusions. The half-life of sugammadex (Org 25969), a new fast and efficient reversal agent for rocuronium-induced block, is relatively short in the Rhesus monkey, implying the possibility to perform neuromuscular block by rocuronium shortly after reversal of a prior block. In translation to the human situation differences in rocuronium sensitivity and kinetics should be taken into account.
Declaration of interest. This study was supported by a grant from Organon. A.B. is employed by Organon and L.H.D.J.B. is a member of their scientific advisory board. H.D.B. is also working as staff anaesthesiologist at the Department of Anaesthesiology at the Martini Hospital Groningen, Groningen, The Netherlands.
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