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Open Access Highly Accessed Research article

Reversal of profound vecuronium-induced neuromuscular block under sevoflurane anesthesia: sugammadex versus neostigmine.

Hendrikus JM Lemmens1*, Mohammad I El-Orbany26, James Berry3, Jovino Ben Morte4 and Gavin Martin5

Author affiliations

1 Stanford University Medical Center, Stanford, CA, USA

2 Advocate Illinois Masonic Medical Center, Chicago, IL, US

3 Vanderbilt University Medical Center, Nashville, TN, USA

4 Merck Research Laboratories, Summit, New Jersey, USA

5 Duke University Medical Center, Durham, NC, USA

6 The Medical College of Wisconsin, Milwaukee, WI, USA

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Citation and License

BMC Anesthesiology 2010, 10:15  doi:10.1186/1471-2253-10-15

Published: 1 September 2010

Abstract

Background

Acetylcholinesterase inhibitors cannot rapidly reverse profound neuromuscular block. Sugammadex, a selective relaxant binding agent, reverses the effects of rocuronium and vecuronium by encapsulation. This study assessed the efficacy of sugammadex compared with neostigmine in reversal of profound vecuronium-induced neuromuscular block under sevoflurane anesthesia.

Methods

Patients aged ≥18 years, American Society of Anesthesiologists class 1-4, scheduled to undergo surgery under general anesthesia were enrolled in this phase III, multicenter, randomized, safety-assessor blinded study. Sevoflurane anesthetized patients received vecuronium 0.1 mg/kg for intubation, with maintenance doses of 0.015 mg/kg as required. Patients were randomized to receive sugammadex 4 mg/kg or neostigmine 70 μg/kg with glycopyrrolate 14 μg/kg at 1-2 post-tetanic counts. The primary efficacy variable was time from start of study drug administration to recovery of the train-of-four ratio to 0.9. Safety assessments included physical examination, laboratory data, vital signs, and adverse events.

Results

Eighty three patients were included in the intent-to-treat population (sugammadex, n = 47; neostigmine, n = 36). Geometric mean time to recovery of the train-of-four ratio to 0.9 was 15-fold faster with sugammadex (4.5 minutes) compared with neostigmine (66.2 minutes; p < 0.0001) (median, 3.3 minutes with sugammadex versus 49.9 minutes with neostigmine). No serious drug-related adverse events occurred in either group.

Conclusions

Recovery from profound vecuronium-induced block is significantly faster with sugammadex, compared with neostigmine. Neostigmine did not rapidly reverse profound neuromuscular block (Trial registration number: NCT00473694).