Sugammadex Reversal of Rocuronium and Vecuronium

Reversal of neuromuscular block may occur spontaneously or is hastened with acetylcholinesterase inhibitors such as neostigmine or eDROPhonium. Sugammadex is a selective relaxant binding agent used for rapid reversal of rocuronium and vecuronium-induced neuromuscular blockade.Objectives: To assess the dose-response relationship of sugammadex as a reversal agent after rocuronium and vecuronium-induced block.Patients and methods: Sixty patients were scheduled for elective general surgery procedures with a standardized anesthetic technique. They were randomly received 0.6 mg/kg rocuronium (rocuronium group, n = 30) or 0.1 mg/kg vecuronium (vecuronium group, n = 30) to facilitate endotracheal intubation with maintenance doses as needed. The neuromuscular block of the adductor pollicis muscle was monitored using the peripheral nerve stimulator. At reappearance of T2, each main group was divided into three equal subgroups (n = 10) and a single-dose sugammadex 1, 3 and 5 mg/kg was administered. The time required for recovery to T4 of TOF stimulation from the start of sugammadex administration was determined. Also,mean arterial blood pressure, heart rate and signs of recurrence of neuromuscular block were monitored.Results: There was a highly significant dose-response relationship for mean recovery time (T4 appearance with TOF stimulation) with increasing sugammadex dose in both studied groups; rocuronium, 14.1 ± 1.8 minutes (5 mg/kg), vecuronium, 15.4 ± 1.4 minutes, 3.6 ± 0.9 minutes and 1.4 ± 0.25 minutes with sugammadex 1, 3, or 5 mg/kg respectively. Hemodynamic stability was observed with sugammadex. Signs of recurrence of block were reported in two patients with sugammadex 1 mg/kg in both groups.Conclusion: Sugammadex provides an effective, rapid reversal of both rocuronium- and vecuronium-induced neuromuscular blockade in a dose-response manner.