The combination of sugammadex and neostigmine can reduce the dosage of sugammadex
during recovery from the moderate neuromuscular blockade
#MMPMID26634077
Cheong SH
; Ki S
; Lee J
; Lee JH
; Kim MH
; Hur D
; Cho K
; Lim SH
; Lee KM
; Kim YJ
; Lee W
Korean J Anesthesiol
2015[Dec]; 68
(6
): 547-55
PMID26634077
show ga
BACKGROUND: Sugammadex is a novel neuromuscular reversal agent, but its
associated hypersensitivity reaction and high cost have been obstacles to its
widespread use. In the interest of reducing the necessary dosage of sugammadex,
the reversal time of the combined use of sugammadex and neostigmine from moderate
neuromuscular blockade were investigated. METHODS: The patients enrolled ranged
in age from 18 to 65 years old with American Society of Anesthesiologists class 1
or 2. The subjects were randomly assigned into one of the four groups (Group S2,
S1, SN, and N; n = 30 per group). The reversal agents of each groups were as
follows: S2 - sugammadex 2 mg/kg, S1 - sugammadex 1 mg/kg, SN - sugammadex 1
mg/kg + neostigmine 50 µg/kg + glycopyrrolate 10 µg/kg, N - neostigmine 50 µg/kg
+ glycopyrrolate 10 µg/kg. The time to recovery of the train-of-four (TOF) ratio
was checked in each group. RESULTS: The time to 90% recovery of TOF ratio was
182.6 ± 88.9, 371.1 ± 210.4, 204.3 ± 103.2, 953.2 ± 379.7 sec in group S2, S1, SN
and N, respectively. Group SN showed a significantly shorter recovery time than
did group S1 and N (P < 0.001). However, statistically significant differences
between the S2 and SN groups were not be observed (P = 0.291). No
hypersensitivity reactions occurred in all groups. CONCLUSIONS: For the reversal
from rocuronium-induced moderate neuromuscular blockade, the combined use of
sugammadex and neostigmine may be helpful to decrease the recovery time and can
also reduce the required dosage of sugammadex. However, the increased incidence
of systemic muscarinic side effects must be considered.
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