MedWire News: Sugammadex is effective for the reversal of deep neuromuscular blockade in patients under sevoflurane anesthesia, report researchers.

“Sevoflurane enhances the neuromuscular blocking effect of rocuronium,” explain Philippe Duvaldestin (Hôpital Henri Mondor, Créteil, France) and colleagues. “Therefore, theoretically, the efficacy of sugammadex in reversing rocuronium-induced neuromuscular blockade may be diminished under sevoflurane anesthesia.”

Duvaldestin et al randomly assigned 102 patients, scheduled for elective surgery under propofol-induced and sevoflurane-maintained anesthesia, to receive a rocuronium 0.9 mg/kg or vecuronium 0.1 mg/kg bolus, followed by as-needed doses to maintain neuromuscular blockade at 1 to 2 posttetanic counts.

The patients received sugammadex at doses of 0.5, 1.0, 2.0, 4.0, or 8.0 mg/kg to reverse neuromuscular blockade. The average times to achieve a train-of-fours (TOF) ratio of 0.9 with these doses were 79.8, 28.0, 3.2, 1.7, and 1.1 minutes, respectively, in the rocuronium group, and 68.4, 25.1, 9.1, 3.3, and 1.7 minutes, respectively, in the vecuronium group.

Three patients experienced recurrent neuromuscular blockade, defined as a decrease in TOF ratio from 0.9 or higher to less than 0.8. These patients had all received low sugammadex doses (0.5 or 1.0 mg/kg) and none suffered a clinical event attributable to the recurrence.

Four patients suffered serious adverse events, but none was thought to be related to the study drugs. The events included wound hemorrhage, laryngeal edema, convulsions, and bacterial meningitis.

“Sugammadex seems equally effective for reversal of rocuronium-induced neuromuscular blockade whether anesthesia is maintained with propofol or sevoflurane,” the team concludes in the journal Anesthesia and Analgesia.

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