Recovery from prolonged deep rocuronium-induced neuromuscular blockade

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• 作者：Prof. N. Rahe-Meyer ; C. Berger ; M. Wittmann ; C. Solomon ; E.A.M. Abels…
• 关键词：Neuromuscular blockade ; Placebo ; Rocuronium ; Sugammadex ; Neuromuskul?re Blockade ; Plazebo ; Rocuronium ; Sugammadex
• 刊名：Der Anaesthesist
• 出版年：2015
• 出版时间：July 2015
• 年：2015
• 卷：64
• 期：7
• 页码：506-512
• 全文大小：447 KB
• 参考文献：1.Baillard C, Gehan G, Reboul-Marty J et al (2000) Residual curarization in the recovery room after vecuronium. Br J Anaesth 84:394-95PubMed View Article
  2.Berg H, Roed J, Viby-Mogensen J et al (1997) Residual neuromuscular block is a risk factor for postoperative pulmonary complications. A prospective, randomised, and blinded study of postoperative pulmonary complications after atracurium, vecuronium and pancuronium. Acta Anaesthesiol Scand 41:1095-103PubMed View Article
  3.Murphy GS, Szokol JW, Marymont JH et al (2008) Residual neuromuscular blockade and critical respiratory events in the postanesthesia care unit. Anesth Analg 107:130-37PubMed View Article
  4.Jones RK, Caldwell JE, Brull SJ, Soto RG (2008) Reversal of profound rocuronium-induced blockade with sugammadex: a randomized comparison with neostigmine. Anesthesiology 109:816-24PubMed View Article
  5.Plaud B, Debaene B, Donati F, Marty J (2010) Residual paralysis after emergence from anesthesia. Anesthesiology 112:1013-022PubMed View Article
  6.Grayling M, Sweeney BP (2007) Recovery from neuromuscular blockade: a survey of practice. Anaesthesia 62:806-09PubMed View Article
  7.Blobner M, Eriksson LI, Scholz J et al (2010) Reversal of rocuronium-induced neuromuscular blockade with sugammadex compared with neostigmine during sevoflurane anaesthesia: results of a randomised, controlled trial. Eur J Anaesthesiol 27:874-81PubMed View Article
  8.Lemmens HJ, El-Orbany MI, Berry J et al (2010) Reversal of profound vecuronium-induced neuromuscular block under sevoflurane anesthesia: sugammadex versus neostigmine. BMC Anesthesiol 10:15PubMed Central PubMed View Article
  9.Khuenl-Brady KS, Wattwil M, Vanacker BF et al (2010) Sugammadex provides faster reversal of vecuronium-induced neuromuscular blockade compared with neostigmine: a multicenter, randomized, controlled trial. Anesth Analg 110:64-3PubMed View Article
  10.Fuchs-Buder T, Claudius C, Skovgaard LT et al (2007) Good clinical research practice in pharmacodynamic studies of neuromuscular blocking agents II: the Stockholm revision. Acta Anaesthesiol Scand 51:789-08PubMed View Article
  11.Aldrete JA (1995) The post-anesthesia recovery score revisited. J Clin Anesth 7:89-1PubMed View Article
  12.Bhananker SM, Posner KL, Cheney FW et al (2006) Injury and liability associated with monitored anesthesia care: a closed claims analysis. Anesthesiology 104:228-34PubMed View Article
  13.Geldner G, Niskanen M, Laurila P et al (2012) A randomised controlled trial comparing sugammadex and neostigmine at different depths of neuromuscular blockade in patients undergoing laparoscopic surgery. Anaesthesia 67:991-98PubMed View Article
  14.Duvaldestin P, Kuizenga K, Saldien V et al (2010) A randomized, dose-response study of sugammadex given for the reversal of deep rocuronium- or vecuronium-induced neuromuscular blockade under sevoflurane anesthesia. Anesth Analg 110:74-2PubMed View Article
  15.Maybauer DM, Geldner G, Blobner M et al (2007) Incidence and duration of residual paralysis at the end of surgery after multiple administrations of cisatracurium and rocuronium. Anaesthesia 62:12-7PubMed View Article
  16.Naguib M, Kopman AF, Lien CA et al (2010) A survey of current management of neuromuscular block in the United States and Europe. Anesth Analg 111:110-19PubMed
  17.Ledowski T, Falke L, Johnston F et al (2014) Retrospective investigation of postoperative outcome after reversal of residual neuromuscular blockade: sugammadex, neostigmine or no reversal. Eur J Anaesthesiol 31:423-29PubMed View Article
  
• 作者单位：Prof. N. Rahe-Meyer (1) (2)
  C. Berger (3)
  M. Wittmann (4)
  C. Solomon (2) (5) (6)
  E.A.M. Abels (7) (8)
  H. Rietbergen (7)
  D.A. Reuter (9)
  
  1. Department of Anaesthesiology and Intensive Care, Franziskus Hospital, Kiskerstr. 26, 33615, Bielefeld, Germany
  2. Department of Anaesthesiology, Hannover Medical School, Hannover, Germany
  3. Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
  4. Department of Anesthesiology, University Hospital Bonn, Bonn, Germany
  5. Department of Anesthesiology, Perioperative Medicine and General Intensive Care, Paracelsus Medical University, Salzburg, Austria
  6. CSL-Behring, Marburg, Germany
  7. MSD, Oss, The Netherlands
  8. Clinical Trial Manager, Philips Digital Pathology, Philips Group Innovation, Best, The Netherlands
  9. Department of Anesthesiology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Anesthesiology
  Emergency Medicine
  Intensive and Critical Care Medicine
  Pain Medicine
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1432-055X

文摘

Background Deep neuromuscular blockade (NMB) may not always be maintained to the end of surgery and the depth of block may be allowed to gradually diminish over time, particularly if reversal of NMB is not routinely performed. Aim The current study aimed to assess recovery from deep rocuronium-induced NMB with sugammadex compared with placebo, provide data regarding the extent of residual blockade after deep rocuronium-induced NMB (placebo group), and to determine whether complete and reliable recovery could be provided by sugammadex (sugammadex group). Materials and methods This was a randomized, placebo-controlled, safety-assessor-blinded study in adult patients of American Society of Anesthesiologists Class I to III. Patients with clinically relevant kidney or liver insufficiency were excluded. Anesthesia was administered as routinely practiced at each study site. Rocuronium 0.6?mg/kg was administered for intubation, with maintenance doses of 0.1-.2?mg/kg as needed. After the last rocuronium dose, at deep NMB (target depth 1- post-tetanic counts), patients received a single dose of sugammadex 4.0?mg/kg or placebo as randomized. The primary endpoint was time from sugammadex or placebo administration to recovery of the train-of-four (TOF) ratio to 0.9. Safety was assessed through monitoring of adverse events, vital signs and physical examination. Patients were also assessed for evidence of residual or recurrence of NMB. With this design, the study will provide data regarding the extent of residual blockade under these conditions (placebo group), and determine whether complete and reliable recovery could be provided by sugammadex (sugammadex group). Results Recovery to a TOF ratio of ≥-.9 with sugammadex was significantly faster (~-0 times) than spontaneous recovery: geometric mean (95- confidence interval) times were 2.2 (1.9-.5) and 89.8 (80.1-00.7) min, respectively (p-lt;-.0001, N--34); maximum spontaneous recovery was 289.8?min. Safety was comparable between groups, with no recurrence of blockade. Conclusions This study confirms a prolonged residual blockade in patients who did not receive sugammadex, with median time to recovery >-.5?h in the placebo group and one patient taking 4.8?h to achieve a safe level of neuromuscular function recovery following deep NMB. In contrast, sugammadex provided complete and reliable recovery of neuromuscular function (median time to recovery of 2.0?min). Thus, deep NMB with rocuronium until the end of the operation may be possible in combination with sugammadex reversal.