Abstract
The objective of this study was to determine the point after sugammadex administration at which sufficient or insufficient dose could be determined, using first twitch height of train-of-four (T1 height) or train-of-four ratio (TOFR) as indicators. Groups A and B received 1 mg/kg and 0.5 mg/kg of sugammadex, respectively, as a first dose when the second twitch reappeared in train-of-four stimulation, and Groups C and D received 1 mg/kg and 0.5 mg/kg of sugammadex, respectively, as the first dose at posttetanic counts 1–3. Five minutes after the first dose, an additional 1 mg/kg of sugammadex was administered and changes in T1 height and TOFR were observed. Patients were divided into a recovered group and a partly recovered group, based on percentage changes in T1 height after additional dosing. T1 height and TOFR during the 5 min after first dose were then compared. In the recovered group, TOFR exceeded 90% in all patients at 3 min after sugammadex administration. In the partly recovered group, none of the patients had a TOFR above 90% at 3 min after sugammadex administration. An additional dose of sugammadex can be considered unnecessary if the train-of-four ratio is ≥90% at 3 min after sugammadex administration. This trial is registered with UMIN000007245.
Highlights
The recommended dose of sugammadex is determined based on the body weight of the patient and is set at 2 mg/kg of patient body weight for reversal of moderate neuromuscular block (NMB), that is, upon reappearance of the second twitch (T2) in train-of-four (TOF) stimulation, and at 4 mg/kg of patient body weight for reversal of deep NMB, that is, posttetanic count (PTC) 1-2
These recommendations have been defined by clinical consensus as the dose capable of exerting a reversal effect on NMB based on patient body weight, irrespective of individual differences
Moderate NMB is sufficiently reversed by 1 mg/kg sugammadex in some patients [1], and the recommended dose of 2 mg/kg sugammadex would constitute an overdose in such patients
Summary
The recommended dose of sugammadex is determined based on the body weight of the patient and is set at 2 mg/kg of patient body weight for reversal of moderate neuromuscular block (NMB), that is, upon reappearance of the second twitch (T2) in train-of-four (TOF) stimulation, and at 4 mg/kg of patient body weight for reversal of deep NMB, that is, posttetanic count (PTC) 1-2. If NMB is required again for reoperation after sugammadex administration, a dose of the blocking agent rocuronium or vecuronium sufficient to overcome the reversal effect of sugammadex must be administered to reinstigate blocking. Against this background, we investigated the possibility of predicting whether the administered dose of sugammadex would be sufficient or insufficient by monitoring first twitch
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