Korean J Anesthesiol.  2013 Dec;65(6):501-507. 10.4097/kjae.2013.65.6.501.

Sugammadex versus neostigmine reversal of moderate rocuronium-induced neuromuscular blockade in Korean patients

• Woo T
• Kim KS
• Shim YH
• Kim MK
• Yoon SM
• Lim YJ
• Yang HS
• Phiri P
• Chon JY

• KMID: 2092375
• DOI: http://doi.org/10.4097/kjae.2013.65.6.501

Abstract

BACKGROUND
Rapid and complete reversal of neuromuscular blockade (NMB) is desirable at the end of surgery. Sugammadex reverses rocuronium-induced NMB by encapsulation. It is well tolerated in Caucasian patients, providing rapid reversal of moderate (reappearance of T2) rocuronium-induced NMB. We investigated the efficacy and safety of sugammadex versus neostigmine in Korean patients.
METHODS
This randomized, safety assessor-blinded trial (NCT01050543) included Korean patients undergoing general anesthesia. Rocuronium 0.6 mg/kg was given prior to intubation with maintenance doses of 0.1-0.2 mg/kg as required. Patients received sugammadex 2.0 mg/kg or neostigmine 50 microg/kg with glycopyrrolate 10 microg/kg to reverse the NMB at the reappearance of T2, after the last rocuronium dose. The primary efficacy endpoint was the time from sugammadex or neostigmine administration to recovery of the train-of-four (TOF) ratio to 0.9. The safety of these medications was also assessed.
RESULTS
Of 128 randomized patients, 118 had evaluable data (n = 59 in each group). The geometric mean (95% confidence interval) time to recovery of the TOF ratio to 0.9 was 1.8 (1.6, 2.0) minutes in the sugammadex group and 14.8 (12.4, 17.6) minutes in the neostigmine group (P < 0.0001). Sugammadex was generally well tolerated, with no evidence of residual or recurrence of NMB; four patients in the neostigmine group reported adverse events possibly indicative of inadequate NMB reversal.
CONCLUSIONS
Sugammadex was well tolerated and provided rapid reversal of moderate rocuronium-induced NMB in Korean patients, with a recovery time 8.1 times faster than neostigmine. These results are consistent with those reported for Caucasian patients.

Keyword

Caucasian; Korean; Neostigmine; Neuromuscular blockade; Rocuronium; Sugammadex

MeSH Terms

Anesthesia, General
Glycopyrrolate
Humans
Intubation
Neostigmine*
Neuromuscular Blockade*
Recurrence
Glycopyrrolate
Neostigmine