Comparison of Rocuronium-Sugammadex and Succinylcholine during Electroconvulsive Therapy: A Small Observational Case Series Study

Abstract

Introduction: The use of neuromuscular relaxants is needed in electroconvulsive therapy (ECT) to minimize the convulsive motor activity. Succinylcholine is the most useful and commonly available neuromuscular relaxant agent for ECT. However, rocuronium with subsequent use of sugammadex was proposed for ECT as an alternative to succinylcholine. Methods: A small case series of four patients with major depressive disorder recruited as part of a preliminary study is presented. The purpose of this study was to investigate the effect of a small dose succinylcholine (0.5 mg/ kg) and rocuronium (0.3 mg/kg)-sugammadex (4 mg/kg) complex on clinical recovery during ECT as well as ECT quality and the incidence of side effects. Results: Forty-eight ECT sessions were conducted in total in the post anesthesia care unit. The mean extent of motor seizure modification score was significantly higher in the group rocuronium-sugammadex (p=0.003). The mean time to resume spontaneous respiration and time to eye opening to verbal command were shorter following rocuronium blockade with 4 mg/ kg of sugammadex compared with succinylcholine (p=0.011 and p=0.028 respectively). Agitation and myalgia were significantly lower in rocuroniumsugammadex group (p=0.043 and p=0.01 respectively). Conclusion: This small case series study demonstrates the efficacy of rocuronium (0.3 mg/kg)–sugammadex (4 mg/kg) as an alternative to succinylcholine (0.5 mg/kg).