Abstract
BackgroundThe effectiveness of sugammadex in reversing rocuronium-induced neuromuscular blockade (NMB) in the presence of drugs that may potentiate NMB remains to be fully established. The aim of this post-hoc analysis of data from a Phase III clinical trial (VISTA; NCT00298831) was to investigate the impact of antibiotics on recovery from rocuronium-induced NMB after administration of sugammadex for reversal, and compared the neuromuscular recovery in patients who received antibiotics preoperatively with those who did not.MethodsA Phase III, multicenter, open-label study designed to reflect potential use of sugammadex in clinical practice was conducted at 19 sites. Data obtained from patients who received antibiotics were compared with the cohort of patients who underwent the same protocol without antibiotics. Each subject received rocuronium 0.6 mg/kg for muscle relaxation, after which tracheal intubation was performed; patients were also permitted to receive maintenance doses of rocuronium 0.15 mg/kg to maintain the desired level of NMB throughout the operation, as required.. At least 15 min after the last rocuronium dose, patients received sugammadex 4.0 mg/kg for reversal. Neuromuscular monitoring was continued until a train-of-four (TOF) ratio of ≥0.9 was achieved or the anesthetic was discontinued.ResultsThe presence of antibiotics prior to the administration of sugammadex did not affect the recovery time from rocuronium-induced NMB when sugammadex 4.0 mg/kg was administered at least 15 min after the last dose of rocuronium. In the presence of antibiotics, the geometric mean (95% CI) time from administration of sugammadex 4.0 mg/kg to recovery of the TOF ratio to ≥0.9 was 1.6 (1.4–1.9) min (range: 0.7–10.5 min), compared with 2.0 (1.8–2.3) min (range: 0.7–22.3 min) for patients who did not receive antibiotics.ConclusionsThese findings suggest that prophylactic antibiotic use is unlikely to have a major impact on the recovery time from rocuronium-induced NMB with sugammadex reversal.Trial registrationClinicalTrials.gov Identifier: NCT00298831.
Highlights
The effectiveness of sugammadex in reversing rocuronium-induced neuromuscular blockade (NMB) in the presence of drugs that may potentiate NMB remains to be fully established
Since neostigmine works by reducing enzymatic breakdown of acetylcholine in the neuromuscular junction to increase the concentration of acetylcholine, thereby shifting the competition between acetylcholine and the neuromuscular blocking agents (NMBAs) for the binding site in favor of acetylcholine, a reduced availability of acetylcholine may subsequently limit the effectiveness of neostigmine
In the current post-hoc analysis to establish the impact of antibiotic administration on the ability of sugammadex to reverse the muscle relaxant property of rocuronium, data obtained from sugammadex-treated patients who received antibiotics were compared with the cohort of patients who underwent the same protocol without antibiotics
Summary
The effectiveness of sugammadex in reversing rocuronium-induced neuromuscular blockade (NMB) in the presence of drugs that may potentiate NMB remains to be fully established. The effectiveness of sugammadex in reversing rocuronium in the presence of drugs that potentiate NMB remains to be fully established. The presence of certain antibiotics may limit the ability of traditional reversal agents such as neostigmine to reverse NMB [6,12]. A reduced concentration of acetylcholine would reduce competition for the NMBA to bind to the nicotinic acetylcholine receptor , thereby potentiating the NMB. Since neostigmine works by reducing enzymatic breakdown of acetylcholine in the neuromuscular junction to increase the concentration of acetylcholine, thereby shifting the competition between acetylcholine and the NMBA for the binding site in favor of acetylcholine, a reduced availability of acetylcholine may subsequently limit the effectiveness of neostigmine
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