Management of Muscle Relaxation With Rocuronium and Reversal With Neostigmine or Sugammadex Guided by Quantitative Neuromuscular Monitoring
Authors' conclusion
A protocol that includes quantitative monitoring to guide reversal with neostigmine or sugammadex and to confirm TOF ratio ≥0.9 before extubation resulted in the complete prevention of PRNB.
Study context
- Population
- Patients scheduled for elective surgery with intraoperative rocuronium189 completed
- Participants
- 200 patients
- Exposure
- Reversal with neostigmine (train-of-four (TOF) ratio 0.40 to 0.89) or sugammadex (deeper blockade), guided by quantitative monitoring
- Neostigminen = 66
- Sugammadexn = 90
- Recovered spontaneouslyn = 33
- Outcome
- Incidence of postoperative residual neuromuscular blockade (PRNB; TOF ratio <0.9 at extubation)
- Follow-up
- At time of extubation
Methodological detailsprotocolised reversal guided by quantitative (electromyography-based) monitoring
- Protocolised reversal guided by quantitative (electromyography-based) monitoring
Main finding
As reported in the abstract
PRNB (overall)
Overall incidence of residual paralysis
0%
95% CI 0–1.9
Observational data: associations, not effects.
Further findings
Acquisition cost of reversal drugs vs projected cost if sugammadex in all patients
United States dollar (USD)
- Total cost, protocol (USD 60 per patient)
- 11,358
- Projected total cost, sugammadex for all (USD 103 per patient, 70% higher)
- 19,312
Original publication
Management of Muscle Relaxation With Rocuronium and Reversal With Neostigmine or Sugammadex Guided by Quantitative Neuromuscular Monitoring. Anesth Analg. Published 12 May 2023. doi:10.
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