Skip to main content
Top
Published in: Journal of Anesthesia 2/2020

01-04-2020 | General Anesthesia | Original Article

Use of intraoperative neuromuscular monitor reduces the reversal dose of sugammadex: a single-center retrospective study

Authors: Hajime Iwasaki, Atsushi Kurosawa, Takafumi Iida, Tomoki Sasakawa, Hirotsugu Kanda

Published in: Journal of Anesthesia | Issue 2/2020

Login to get access

Abstract

Purpose

We compared the reversal doses of sugammadex in surgical cases in which intraoperative neuromuscular monitor were used, to cases in which intraoperative neuromuscular monitoring was not used, retrospectively.

Methods

Data were collected by reviewing the electronic medical records of patients who received rocuronium and sugammadex during general anesthesia at Asahikawa Medical University Hospital between May 1, 2017 and April 30, 2018. The primary outcome was the reversal dose of sugammadex per patient actual body weight (mg/kg) between the group in which intraoperative neuromuscular monitoring was used (NM+ group) and the group in which intraoperative neuromuscular monitoring was not used (NM− group).

Results

A total of 3496 patients were evaluated, with 2544 patients (73%) included in NM+ group and 952 patients (27%) in NM− group. The reversal doses of sugammadex per actual body weight were significantly higher in NM− group compared to NM+ group. In the NM+ group, 521 patients (20%) received < 2 mg/kg sugammadex, 1377 patients (54%) received 2 ~ 2.5 mg/kg sugammadex, and 646 patients (25%) received > 2.5 mg/kg sugammadex. In contrast, 128 patients (13%) received < 2 mg/kg sugammadex, 362 patients (38%) received 2 ~ 2.5 mg/kg sugammadex and 462 patients (49%) received > 2.5 mg/kg sugammadex in NM− group.

Conclusion

This single-center retrospective study demonstrated that the use of intraoperative neuromuscular monitor reduced the reversal dose of sugammadex.
Literature
1.
go back to reference Bom A, Hope F, Rutherford S, Thomson K. Preclinical pharmacology of sugammadex. J Crit Care. 2009;24:29–35.CrossRef Bom A, Hope F, Rutherford S, Thomson K. Preclinical pharmacology of sugammadex. J Crit Care. 2009;24:29–35.CrossRef
2.
go back to reference Naguib M, Kopman AF, Lien CA, Hunter JM, Lopez A, Brull SJ. A survey of current management of neuromuscular block in the United States and Europe. Anesth Analg. 2010;111:110–9.CrossRef Naguib M, Kopman AF, Lien CA, Hunter JM, Lopez A, Brull SJ. A survey of current management of neuromuscular block in the United States and Europe. Anesth Analg. 2010;111:110–9.CrossRef
3.
go back to reference Grayling M, Sweeney BP. Recovery from neuromuscular blockade: a survey of practice. Anaesthesia. 2007;62:806–9.CrossRef Grayling M, Sweeney BP. Recovery from neuromuscular blockade: a survey of practice. Anaesthesia. 2007;62:806–9.CrossRef
4.
go back to reference Di Marco P, Della Rocca G, Iannuccelli F, Pompei L, Reale C, Pietropaoli P. Knowledge of residual curarization: an Italian survey. Acta Anaesthesiol Scand. 2010;54:307–12.CrossRef Di Marco P, Della Rocca G, Iannuccelli F, Pompei L, Reale C, Pietropaoli P. Knowledge of residual curarization: an Italian survey. Acta Anaesthesiol Scand. 2010;54:307–12.CrossRef
5.
go back to reference Fuchs-Buder T, Hofmockel R, Geldner G, Diefenbach C, Ulm K, Blobner M. The use of neuromuscular monitoring in Germany. Anaesthesist. 2003;52:522–6.CrossRef Fuchs-Buder T, Hofmockel R, Geldner G, Diefenbach C, Ulm K, Blobner M. The use of neuromuscular monitoring in Germany. Anaesthesist. 2003;52:522–6.CrossRef
6.
go back to reference Domenech G, Kampel MA, Garcia Guzzo ME, Novas DS, Terrasa SA, Fornari GG. Usefulness of intra-operative neuromuscular blockade monitoring and reversal agents for postoperative residual neuromuscular blockade: a retrospective observational study. BMC Anesthesiol. 2019;19:143.CrossRef Domenech G, Kampel MA, Garcia Guzzo ME, Novas DS, Terrasa SA, Fornari GG. Usefulness of intra-operative neuromuscular blockade monitoring and reversal agents for postoperative residual neuromuscular blockade: a retrospective observational study. BMC Anesthesiol. 2019;19:143.CrossRef
7.
go back to reference Milne JI, Ong CS, Ong JS, Cheung KC, Schauer AA, Buttar SB, Ledowski T. The influence of introducing unrestricted access to sugammadex and quantitative neuromuscular monitors on the incidence of residual neuromuscular block at a tertiary teaching hospital. An audit of ‘real-life’. Anaesth Intensive Care. 2016;44:784.CrossRef Milne JI, Ong CS, Ong JS, Cheung KC, Schauer AA, Buttar SB, Ledowski T. The influence of introducing unrestricted access to sugammadex and quantitative neuromuscular monitors on the incidence of residual neuromuscular block at a tertiary teaching hospital. An audit of ‘real-life’. Anaesth Intensive Care. 2016;44:784.CrossRef
8.
go back to reference Kotake Y, Ochiai R, Suzuki T, Ogawa S, Takagi S, Ozaki M, Nakatsuka I, Takeda J. Reversal with sugammadex in the absence of monitoring did not preclude residual neuromuscular block. Anesth Analg. 2013;117:345–51.CrossRef Kotake Y, Ochiai R, Suzuki T, Ogawa S, Takagi S, Ozaki M, Nakatsuka I, Takeda J. Reversal with sugammadex in the absence of monitoring did not preclude residual neuromuscular block. Anesth Analg. 2013;117:345–51.CrossRef
9.
go back to reference Iwasaki H, Takahoko K, Otomo S, Sasakawa T, Kunisawa T, Iwasaki H. A temporary decrease in twitch response following reversal of rocuronium-induced neuromuscular block with a small dose of sugammadex in a pediatric patient. J Anesth. 2014;28:288–90.CrossRef Iwasaki H, Takahoko K, Otomo S, Sasakawa T, Kunisawa T, Iwasaki H. A temporary decrease in twitch response following reversal of rocuronium-induced neuromuscular block with a small dose of sugammadex in a pediatric patient. J Anesth. 2014;28:288–90.CrossRef
10.
go back to reference Duvaldestin P, Kuizenga K, Saldien V, Claudius C, Servin F, Klein J, Debaene B, Heeringa M. A randomized, dose-response study of sugammadex given for the reversal of deep rocuronium- or vecuronium-induced neuromuscular blockade under sevoflurane anesthesia. Anesth Analg. 2010;110:74–82.CrossRef Duvaldestin P, Kuizenga K, Saldien V, Claudius C, Servin F, Klein J, Debaene B, Heeringa M. A randomized, dose-response study of sugammadex given for the reversal of deep rocuronium- or vecuronium-induced neuromuscular blockade under sevoflurane anesthesia. Anesth Analg. 2010;110:74–82.CrossRef
11.
go back to reference Eleveld DJ, Kuizenga K, Proost JH, Wierda JM. A temporary decrease in twitch response during reversal of rocuronium-induced muscle relaxation with a small dose of sugammadex. Anesth Analg. 2007;104:582–4.CrossRef Eleveld DJ, Kuizenga K, Proost JH, Wierda JM. A temporary decrease in twitch response during reversal of rocuronium-induced muscle relaxation with a small dose of sugammadex. Anesth Analg. 2007;104:582–4.CrossRef
12.
go back to reference Iwasaki H, Renew JR, Kunisawa T, Brull SJ. Preparing for the unexpected: special considerations and complications after sugammadex administration. BMC Anesthesiol. 2017;17:140.CrossRef Iwasaki H, Renew JR, Kunisawa T, Brull SJ. Preparing for the unexpected: special considerations and complications after sugammadex administration. BMC Anesthesiol. 2017;17:140.CrossRef
13.
go back to reference Iwasaki H, Sasakawa T, Takahoko K, Takagi S, Nakatsuka H, Suzuki T, Iwasaki H. A case series of re-establishment of neuromuscular block with rocuronium after sugammadex reversal. J Anesth. 2016;30:534–7.CrossRef Iwasaki H, Sasakawa T, Takahoko K, Takagi S, Nakatsuka H, Suzuki T, Iwasaki H. A case series of re-establishment of neuromuscular block with rocuronium after sugammadex reversal. J Anesth. 2016;30:534–7.CrossRef
14.
go back to reference Takazawa T, Mitsuhata H, Mertes PM. Sugammadex and rocuronium-induced anaphylaxis. J Anesth. 2016;30:290–7.CrossRef Takazawa T, Mitsuhata H, Mertes PM. Sugammadex and rocuronium-induced anaphylaxis. J Anesth. 2016;30:290–7.CrossRef
15.
go back to reference Pongracz A, Szatmari S, Nemes R, Fulesdi B, Tassonyi E. Reversal of neuromuscular blockade with sugammadex at the reappearance of four twitches to train-of-four stimulation. Anesthesiology. 2013;119:36–42.CrossRef Pongracz A, Szatmari S, Nemes R, Fulesdi B, Tassonyi E. Reversal of neuromuscular blockade with sugammadex at the reappearance of four twitches to train-of-four stimulation. Anesthesiology. 2013;119:36–42.CrossRef
16.
go back to reference Batistaki C, Vagdatli K, Tsiotou A, Papaioannou A, Pandazi A, Matsota P. A multicenter survey on the use of neuromuscular blockade in Greece. Does the real-world clinical practice indicate the necessity of guidelines? J Anaesthesiol Clin Pharmacol. 2019;35:202–14.CrossRef Batistaki C, Vagdatli K, Tsiotou A, Papaioannou A, Pandazi A, Matsota P. A multicenter survey on the use of neuromuscular blockade in Greece. Does the real-world clinical practice indicate the necessity of guidelines? J Anaesthesiol Clin Pharmacol. 2019;35:202–14.CrossRef
17.
go back to reference Ledowski T, Ong JS, Flett T. Neuromuscular monitoring, muscle relaxant use, and reversal at a tertiary teaching hospital 2.5 years after introduction of sugammadex: changes in opinions and clinical practice. Anesthesiol Res Pract. 2015;2015:367937.PubMedPubMedCentral Ledowski T, Ong JS, Flett T. Neuromuscular monitoring, muscle relaxant use, and reversal at a tertiary teaching hospital 2.5 years after introduction of sugammadex: changes in opinions and clinical practice. Anesthesiol Res Pract. 2015;2015:367937.PubMedPubMedCentral
Metadata
Title
Use of intraoperative neuromuscular monitor reduces the reversal dose of sugammadex: a single-center retrospective study
Authors
Hajime Iwasaki
Atsushi Kurosawa
Takafumi Iida
Tomoki Sasakawa
Hirotsugu Kanda
Publication date
01-04-2020
Publisher
Springer Singapore
Published in
Journal of Anesthesia / Issue 2/2020
Print ISSN: 0913-8668
Electronic ISSN: 1438-8359
DOI
https://doi.org/10.1007/s00540-020-02739-1

Other articles of this Issue 2/2020

Journal of Anesthesia 2/2020 Go to the issue

Letter to the Editor

Reply to the letter