High-dose sugammadex speeds reversal of neuromuscular block
Thibault Loupec, M.D., from the University of Poitiers in France, and colleagues conducted a single-center randomized trial in 50 morbidly obese patients. Neuromuscular blockade was monitored using acceleromyography at the adductor pollicis. Patients were randomized to sugammadex 4 mg/kg−1 (high-dose group), 2 mg/kg−1 (middle-dose group), and 1 mg/kg−1 (low-dose group) of ideal body weight at the end of surgery with deep rocuronium-induced neuromuscular blockade.
The researchers found that the mean recovery time from deep neuromuscular blockade was significantly shorter in the high-dose group versus the middle- or low-dose group after administration of the first dose of sugammadex (255 versus 429 and 581 seconds, respectively; P < 0.001). For the high-, middle-, and low-dose groups, success rates were 93, 77, and 22 percent, respectively, from neuromuscular blockade reversal defined by a train-of-four ≥0.9 within 10 minutes after sugammadex administration (P < 0.05 compared with the lose-dose group).
"In morbidly obese patients, 4 mg/kg−1 of ideal body weight of sugammadex allows suitable reversal of deep rocuronium-induced neuromuscular blockade," the authors write. "Monitoring remains essential to detect residual curarisation or recurarisation."
One author disclosed financial ties to Merck Sharp & Dohme.
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