Reversal of profound and "deep" residual rocuronium-induced neuromuscular blockade by sugammadex: a neurophysiological study

Pavoni V et al - Neurophysiological monitoring using myogenic motor evoked potentials (mMEPs) confirmed that sugammadex provided a complete recovery from profound and “deep” residual rocuronium–induced neuromuscular blockade.

Methods

• In this prospective trial, 30 consenting patients undergoing propofol-remifentanil anesthesia for spine surgery were enrolled and divided into two groups: Group 1, reversal of profound NMB (sugammadex 16mg/Kg, 3minutes after rocuronium 1.2mg/Kg) and Group 2, reversal of “deep” residual NMB (sugammadex 4mg/Kg, 15minutes after rocuronium 0.6mg/Kg).
• Myogenic MEPs registrations of upper and lower limbs and the diaphragm were performed, as well as TOF monitoring.

Results

• After injection of 4mg/Kg of sugammadex, the means of recovery time of the basal mMEPs amplitudes (diaphragm, and lower limbs and upper limbs) were 124±9.6, 143±163, 151±207sec, respectively whereas after 16mg/Kg of sugammadex the times were 109±13.8, 124±0.6, and 135±14.1sec.
• Times to TOF ratio 0.9 were 114±75 and 186±105sec in Group 1 and 2, respectively.
• No serious adverse effects related to sugammadex and to electrical stimulation were reported.
• No reoccurrence of neuromuscular block was observed.

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