White Paul F, Tufanogullari Burcu, Sacan Ozlem, Pavlin Edward G, Viegas Oscar J, Minkowitz Harold S, Hudson M E
Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, 5161 Harry Hines Boulevard, CS 2. 282, Dallas, TX 75390-9068, USA.
Anesth Analg. 2009 Mar;108(3):846-51. doi: 10.1213/ane.0b013e31818a9932.
Sugammadex is a modified gamma cyclodextrin compound which encapsulates rocuronium resulting in rapid reversal of residual neuromuscular blockade. We performed a post hoc analysis of data from a multicenter study designed to mimic standard clinical practice which would test the hypothesis that the presence (versus the absence) of a twitch response to neuromuscular stimulation at the time of reversal drug administration would influence the speed and completeness of the reversal effect of sugammadex.
One-hundred-seventy-one consenting patients undergoing general anesthesia with a volatile-based anesthetic technique were enrolled in a multicenter observational study. All patients received rocuronium, 0.6 mg/kg i.v. for tracheal intubation and maintenance boluses of 0.15 mg/kg i.v. as needed during surgery. The degree of rocuronium-induced blockade was assessed during anesthesia using a TOF-Watch-SX acceleromyograph to record the train-of-four (TOF) responses on a laptop computer from induction of anesthesia until the TOF ratio returned to > or = 0.9 after completion of the surgical procedure. The patients received sugammadex, 4 mg/kg i.v., for reversal of neuromuscular blockade > 15 min after the last dose of rocuronium. Recovery data were compared in patients with either no (0) (n = 89) or > or = 1 twitch (n = 82) in response to TOF stimulation at the time of reversal drug administration.
The patients without a twitch response were more likely to be female (60% vs 40%) and had a shorter time interval between the last bolus dose of rocuronium and the administration of the reversal drug (31+/-18 vs 45+/-23 min, P < 0.05). The time to achieve a TOF ratio of 0.9 was prolonged in the 0 twitch group compared with the > or = 1 twitch response group (173+/-162 vs 104+/-73 s, P < 0.05). Overall, 84% of the patients in the 0 twitch group recovered to a TOF of 0.9 in < or = 5 min compared to 91% of the patients in the group with > or = 1 twitch (P < 0.05). The times to achieve a TOF of 0.9 varied from 0.8 to 22.3 and 0.7 to 8.5 min in the 0 twitch and > or = 1 twitch groups, respectively.
Reversal of rocuronium-induced neuromuscular blockade by sugammadex was influenced by the degree of residual blockade at the time the reversal drug was administered. Despite the wide variability, reversal of the TOF ratio to 0.9 occurred < or = 5 min in more than 80% of the patients regardless of the number of twitches at the time of reversal drug administration.
舒更葡糖钠是一种改性γ-环糊精化合物，它可包裹罗库溴铵，从而迅速逆转残余的神经肌肉阻滞。我们对一项多中心研究的数据进行了事后分析，该研究旨在模拟标准临床实践，以检验以下假设：在给予逆转药物时，对神经肌肉刺激有颤搐反应（相对于无颤搐反应）会影响舒更葡糖钠逆转效应的速度和完全程度。
171例接受挥发性麻醉技术全身麻醉的患者参加了一项多中心观察性研究。所有患者均静脉注射罗库溴铵，0.6mg/kg用于气管插管，并在手术期间根据需要静脉注射0.15mg/kg的维持剂量。在麻醉期间，使用TOF-Watch-SX加速度肌动描记器评估罗库溴铵诱导的阻滞程度，从麻醉诱导开始，在笔记本电脑上记录四个成串刺激（TOF）反应，直至手术结束后TOF比值恢复至≥0.9。在最后一剂罗库溴铵给药超过15分钟后，患者接受静脉注射舒更葡糖钠4mg/kg以逆转神经肌肉阻滞。比较在给予逆转药物时对TOF刺激无（0）（n = 89）或≥1次颤搐（n = 82）反应的患者的恢复数据。
无颤搐反应的患者更可能为女性（60%对40%），且从最后一剂罗库溴铵推注到给予逆转药物的时间间隔更短（31±18对45±23分钟，P < 0.05）。与有≥1次颤搐反应的组相比，0次颤搐组达到TOF比值0.9的时间延长（173±162对104±73秒，P < 0.05）。总体而言，0次颤搐组中84%的患者在≤5分钟内恢复至TOF为0.9，而有≥1次颤搐的组中这一比例为91%（P < 0.05）。0次颤搐组和≥1次颤搐组达到TOF为0.9的时间分别为0.8至22.3分钟和0.7至8.5分钟。
舒更葡糖钠对罗库溴铵诱导的神经肌肉阻滞的逆转受给予逆转药物时残余阻滞程度的影响。尽管存在很大差异，但无论给予逆转药物时的颤搐次数如何，超过80%的患者在≤5分钟内TOF比值逆转至0.9。
