New way of dosing sugammadex for termination of vecuronium induced neuromuscular block
Background and Goal of Study: Sugammadex is a selective binding agent that binds
aminosteroid muscle relaxants. Each molecule of sugammadex binds one molecule of muscle
relaxant. To produce the same depth of the neuromuscular block (NMB) much less molecules of
vecuronium are needed than molecules of rocuronium. In theory less sugammadex would be
needed to neutralise the neuromuscular block if vecuronium was used to produce the neuromuscular block. Our aim was to compare reversal of vecuronium induced muscle relaxation between a new way of dosing sugammadex, which takes into account TOF value at the end of the surgery and the amount of vecuronium given during the surgery with neostigmine atropine combination. We also wanted to know how much this dosage regime can save compared to standard per kg dosage.
Materials and Methods: 20 adult patients requiring a general anesthesia for surgery were analysed. The first group of 11 patients (SUG) received sugammadex at the end of the surgery according to the table one for NMB reversal. The second group of 9 patients (NEO) received neostigmine and atropine. Train of four (TOF) value was recorded at the end of the surgery and then continuously until the TOF value reached more than 0.9 and the patient was extubated. The time required for the TOF value reaching 0.9 was compared between the groups. For economical evaluation we compared the amount of sugammadex used in the SUG group to standard sugammadex per kg dosage.
Results and Discussion: Mean time to recovery to a TOF ratio of 0.9 with sugammadex was 5.12
min versus 12.6 min with neostigmine atropine (P < 0.05). No sign of postoperative residual curarisation was observed in the SUG group. For patients in our study 530 mg of sugammadex were used to neutralise the NMB. If standard per kg sugammadex dosing had been used we would have used 2420 mg for the NMB reversal.
Conclusion(s): New dosing for sugammadex was successful in neutralising the NMB regardless
of the TOF value at the end of the surgery. The economic impact of the proposed dosing is significant as an average cost for the vecuronium NMB reversal is reduced from around 80 € to 20 € per patient.
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