Evaluation of a Protocol for the Management of Maintenance and Reversal of Rocuronium Block Using Neostigmine or Sugammadex
Authors' conclusion
The use of a protocol that specifies rocuronium dosing and selective use of sugammadex versus neostigmine based on qualitative assessment of TOF count and fade allowed us to achieve an incidence of PRNB of 3% (95% CI, 1-7) at PACU arrival.
Study context
- Population
- Patients undergoing orthopedic or abdominal surgery requiring neuromuscular blockade with rocuronium, managed per a practice guideline with qualitative train-of-four (TOF) monitoring145 orthopedic, 18 abdominal
- Participants
- 163 patients
- Exposure
- Neostigmine vs Sugammadex
- Neostigminen = 92
- Sugammadexn = 71
- Outcome
- Incidence of PRNB (normalized TOFR <0.9)
- Follow-up
- Arrival to the PACU
Methodological detailspragmatic, prespecified end points, providers blinded to quantitative measurements, Only qualitative monitoring available to anesthesia providers
- Pragmatic
- Prespecified end points
- Providers blinded to quantitative measurements
- Only qualitative monitoring available to anesthesia providers
Main finding
As reported in the abstract
PRNB (nTOFR <0.9), overall · PACU arrival
Overall incidence of postoperative residual neuromuscular blockade (PRNB), 5 of 163
3%
95% CI 1–7
Observational data: associations, not effects.
Secondary outcomes
Severe PRNB (normalized TOFR (nTOFR) <0.7) · postanesthesia care unit (PACU) arrival
- Incidence of severe PRNB
- 1% (95% CI, 0-4)
Subjects with PRNB given neostigmine despite train-of-four ratio (TOFR) <0.4 at reversal · time of reversal
- 3 of the 5 subjects with PRNB had TOFR <0.4 at reversal but received neostigmine (no fade detected qualitatively)
Original publication
Evaluation of a Protocol for the Management of Maintenance and Reversal of Rocuronium Block Using Neostigmine or Sugammadex. Anesth Analg. Published 19 May 2023. doi:10.
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