Reversal of neuromuscular blockade with sugammadex during continuous administration of anaesthetic agents: a double‐blind randomised crossover study using the bispectral index
Open Access
- 5 December 2019
- journal article
- research article
- Published by Wiley in Anaesthesia
- Vol. 75 (5), 583-590
- https://doi.org/10.1111/anae.14897
Abstract
Sugammadex, a specific reversal agent for steroidal neuromuscular blocking drugs, has on occasion been reported to be associated with clinical signs of awakening. We performed a study to systematically search for an increase in bispectral index values and signs of awakening in patients maintained under general anaesthesia following sugammadex administration. Patients, scheduled to receive general anaesthesia with neuromuscular blockade, were included in this double‐blind randomised crossover study. After surgery was completed, and while the train‐of‐four ratio was zero, intravenous anaesthesia was continued with the aim of maintaining the bispectral index in the range of 40–60. Patients then received either sugammadex 4 mg.kg−1 or saline. In cases of incomplete reversal of neuromuscular blockade after 5 min, patients received the other drug. Bispectral index and train‐of‐four monitoring were recorded every minute and clinical signs of awakening noted. Fifty‐one patients completed the study. Median (IQR [range]) bispectral index values increased after sugammadex administration from 49 (43–53 [38–64]) to 63 (53–80 [45–97]) (p < 0.01) with an increase of ≥ 20 in 22 patients; 14 (27%) patients had clinical signs of awakening. Saline had no effect on bispectral index values, clinical signs of awakening or degree of neuromuscular blockade. This study confirms that reversal of neuromuscular blockade with sugammadex may be associated with clinical signs of awakening despite maintenance of anaesthesia. Intravenous anaesthesia should be maintained until complete recovery of muscle function is achieved, especially when sugammadex is administered.Keywords
This publication has 33 references indexed in Scilit:
- Elevated BIS and Entropy values after sugammadex or neostigmine: an electroencephalographic or electromyographic phenomenon?Acta Anaesthesiologica Scandinavica, 2012
- The effect of pyridostigmine on bispectral index during recovery from sevoflurane anesthesiaKorean Journal of Anesthesiology, 2011
- Reversal of Rocuronium-induced Neuromuscular Blockade with Sugammadex in Pediatric and Adult Surgical PatientsAnesthesiology, 2009
- Neuromuscular block and the electroencephalogram during sevoflurane anaesthesiaNeuroReport, 2007
- The Effect of Neuromuscular Block and Noxious Stimulation on Hypnosis Monitoring During Sevoflurane AnesthesiaAnesthesia & Analgesia, 2007
- Quantifying Cortical Activity During General Anesthesia Using Wavelet AnalysisIEEE Transactions on Biomedical Engineering, 2006
- The Influence of a Muscle Relaxant Bolus on Bispectral and Datex-Ohmeda Entropy Values During Propofol-Remifentanil Induced Loss of ConsciousnessAnesthesia & Analgesia, 2005
- Pitfalls and challenges when assessing the depth of hypnosis during general anaesthesia by clinical signs and electronic indicesActa Anaesthesiologica Scandinavica, 2004
- Drug-specific cyclodextrins: The future of rapid neuromuscular block reversalDrugs of the Future, 2003
- The Cerebral and Systemic Effects of Movement in Response to a Noxious Stimulus in Lightly Anesthetized Dogs Possible Modulation of Cerebral Function by Muscle AfferentsAnesthesiology, 1994