MedWire News: Sugammadex provides significantly faster reversal of vecuronium-induced neuromuscular blockade (NMB) than neostigmine, research results show.
Karin Khuenl-Brady (Medical University Innsbruck, Austria) and colleagues found that the reversal of vecuronium-induced NMB was “almost seven times faster with sugammadex compared with neostigmine.”
A total of 100 patients aged at least 18 years and scheduled to undergo surgery under sevoflurane/opioid anesthesia participated in the study. They all received an intubating dose of vecuronium (0.1 mg/kg) and maintenance doses of 0.02 to 0.03 mg/kg if the second twitch of train-of-four (TOF) reappeared.
At the end of surgery and reappearance of second twitch after the last dose of vecuronium was given, the patients were randomly assigned to receive either intravenous sugammadex (2 mg/kg) or neostigmine (50 µg/kg) plus glycopyrolate (10 µg/kg).
Recovery of the TOF ratio to 0.9 took just 2.7 minutes in patients receiving sugammadex compared with 17.9 minutes for those given neostigmine.
The researchers report in the journal Anesthesia and Analgesia that the average recovery times to a TOF of 0.8 and 0.7 were also significantly shorter with sugammadex than with neostigmine.
They note that their results are for patients for whom recovery times to the TOF ratios of 0.7, 0.8, or 0.9 were available. All the patients given sugammadex achieved a TOF of at least 0.9.
With regard to clinical signs of recovery, 60.4% of patients in the sugammadex group and 57.8% of patients in the neostigmine group were awake and oriented before transfer to the recovery room. Only one patient in the sugammadex group and six in the neostigmine group were unable to perform the 5-second head lift before transfer to the recovery room. By discharge from the recovery room, the clinical signs were similar for the two groups.
The incidence of unwanted effects was generally low and similar for the two treatment groups. The incidence of drug-related adverse events was slightly higher for patients receiving neostigmine, at 22.2% compared with 16.6% for those receiving sugammadex. This was largely due to a higher incidence of dry mouth and procedural complications of mild-to-moderate intensity in the latter group, Khuenl-Brady and team report.
They conclude: “The results of this study show that under sevoflurane anesthesia sugammadex is significantly more effective than neostigmine for recovery from NMB induced by vecuronium.”
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2009
Free abstract
