Reversal effect of sugammadex in isoflurane, sevoflurane, and desflurane induced anesthesia: a randomized-controlled clinical study

Year 2013, Volume: 2 Issue: 2, 57 - 64, 08.09.2013

Cevdet Düger , Murat Şahin Ahmet İsbir Sinan Gürsoy Kenan Kaygusuz İclal Özdemir Kol Ali Gökakın Caner Mimaroğlu

https://doi.org/10.12808/bcs.v2i2.26

Abstract

Abstract

Aim. In the present study, we aimed to compare the effects of isoflurane, sevoflurane and desflurane on the effect of sugammadex in reversing neuromuscular block. Methods. Ninty patients who were planned to undergo elective lower abdominal surgery under general anesthesia were included and were randomly assigned to 6 groups of 15. After intubation, group I1 and I2 patients received isoflurane, group S1 and S2 patients received sevoflurane and Group D1 and D2 patients received desflurane volatile anesthetic at 1.25 MAC. TOF values were recorded at the 10th, 20th, 30th, 60th and 90th minutes of the operation by an anesthetist blind to the groups. Group I1, S1 and D1 patients were given 2 mg kg-1 sugammadex and group I2, S2 and D2 patients were given neostigmine after the second response to TOF following the latest rocuronium dose was observed again. In each patient, the time elapsed between sugammadex administrations and 10%, 25% and 90% TOF ratio was recorded. Results. There was no difference among the groups in terms of the time elapsing to reach 10% TOF values while the times elapsing to reach 25% and 90% TOF were found to be the shortest in sevoflurane group and the longest in isoflurane group. Conclusion. We think that inhalation anesthetics used in general anesthetic practice, have different effects on the reversal action of sugammadex in neuromuscular blockade and that reversal effect of sugammadex is faster in patients receiving sevoflurane.

Keywords: Sugammadex, train of four, isoflurane, desflurane, sevoflurane, rocuronium

Özet

Amaç. Bu çalışmada sugamadeksin nöromusküler blokör etkisini geri döndürücü etkisine isofluran, sevofluran ve desfluranın etkilerini kıyaslamayı amaçladık. Yöntem. Genel anestezi altında elektif alt batın operasyonu planlanan 90 hasta çalışmaya alındı ve rasgele 15 er kişilik 6 gruba ayrıldı. Entübasyondan sonra, grup I1 ve I2 hastalar izofluran, grup S1 ve S2 hastalarda sevofluran ve grup D1 ve D2 hastalarda desfluran volatil anestetik olarak 1.25 MAC den aldı. TOF değerleri gruplardan habersiz bir anestezist tarafından operasyonda 10, 20, 30, 60. ve 90. dakikalarda kaydedildi. I1, S1 ve D1 grubu hastalara son rokuronyum dozunun ardından TOF a alınan ikinci yanıtın tekrar gözelnmesi sonrası 2 mg kg-1 sugamadeks ve I2, S2 ve D2 grubu hastalarada yine aynı şekilde neostigmine verildi. Her hastaya, sugamadeks uygulanması ile % 10,% 25 ve% 90 TOF oranı arasındaki süre kaydedildi. Bulgular. Gruplar arasında TOF un %10 a ulaşmasına kadar geçen sure açısından fark bulunamazken TOF un % 90 a ulaşma süresi sevofluran grubunda kısa ve izofluran grubunda en uzun olduğu bulunmuştur. Sonuç. Genel anestezi pratiğinde kullanılan inhalasyon anesteziklerinin sugamamdeksin nöromusküler blokaj geri döndürücü etkinliğini farklı oranlarda etkilediğini ve sevofluran anestezisinde sugamadeksin geri döndürücü etkisinin en hızlı olduğunu düşünmekteyiz.

Anahtar Sözcükler: sugamadeks, dörtlü cevap, isofluran, desfluran, sevofluran, roküronyum

Keywords

Sugammadex, train of four, isoflurane, desflurane, sevoflurane, rocuronium

References

• Bevan DR. Monitoring and reversal of neuromuscular block. Am J Health Syst Pharm. 1999; 56: 10–13.
• Vanacker BF, Vermeyen KM, Struys MM, Rietbergen H, Vandermeersch E, Saldien V, Kalmar AF, Prins ME. Reversal of rocuronium-induced neuromuscular block with the novel drug sugammadex is equally effective under maintenance anesthesia with propofol or sevoflurane. Anesth Analg. 2007; 104: 563-568.
• Zhang M-Q. Drug-specific cyclodextrins: the future of rapid neuromuscular block reversal? Drugs Future 2003; 28: 347–354. de Menezes CC, Peceguini LA, Silva ED, Simões CM. Use of sugammadex after neostigmine incomplete reversal of rocuronium-induced neuromuscular blockade. Rev Bras Anestesiol. 2012; 62: 543-547.
• Barbosa FT, da Cunha RM. Reversal of profound neuromuscular blockade with sugammadex after failure of rapid sequence endotracheal intubation: a case report. Rev Bras Anestesiol. 2012; 62: 281-284.
• Wulf H, Ledowski T, Linstedt U, Proppe D, Sitzlack D. Neuromuscular blocking effects of rocuronium during desflurane, isoflurane, and sevoflurane anaesthesia. Can J Anaesth. 1998; 45: 526-532.
• Kumar N, Mirakhur RK, Symington MJJ, McCarthy GJ. Potency and time course of action of rocuronium during desflurane and isoflurane anaesthesia. Br J Anaesth 1996; 77: 488-491.
• Bock M, Klippel K, Nitsche B, Bach A, Martin E, Motsch J. Rocuronium potency and recovery characteristics during steady-state desflurane, sevoflurane, isoflurane or propofol anaesthesia. Br J Anaesth. 2000; 84: 43-47.
• Shields M, Giovannelli M, Mirakhur RK, Moppett I, Adams J, Hermens Y. Org 25969 (sugammadex), a selective relaxant binding agent for antagonism of prolonged rocuronium-induced neuromuscular block. Br J Anaesth. 2006; 96: 36-43.
• Lowry DW, Mirakhur RK, McCarthy GJ, Carroll MT, McCourt KC. Neuromuscular effects of rocuronium during sevoflurane, isoflurane, and intravenous anesthesia. Anesth Analg. 1998; 87: 936-940.
• Kastrup MR, Marsico FF, Ascoli FO, Becker T, Soares JH, Gomez de Segura IA. Neuromuscular blocking properties of atracurium during sevoflurane or propofol anaesthesia in dogs. Vet Anaesth Analg. 2005; 32: 222-227.
• Sutcliffe DG, Murphy CM, Maslow A, Uppington J, Shorten GD. A comparison of antagonism of rocuronium-induced neuromuscular blockade during sevoflurane and isoflurane anaesthesia. Anaesthesia. 2000; 55: 960-964.
• Reid JE, Breslin DS, Mirakhur RK, Hayes AH. Neostigmine antagonism of rocuronium block during anesthesia with sevoflurane, isoflurane or propofol. Can J Anaesth. 2001; 48: 351-355.
• Illman HL, Laurila P, Antila H, Meretoja OA, Alahuhta S, Olkkola KT. The duration of residual neuromuscular block after administration of neostigmine or sugammadex at two visible twitches during train-of-four monitoring. Anesth Analg. 2011; 112: 63-68.
• Khuenl-Brady KS, Wattwil M, Vanacker BF, Lora-Tamayo JI, Rietbergen H, AlvarezGómez JA. Sugammadex provides faster reversal of vecuronium-induced neuromuscular blockade compared with neostigmine: a multicenter, randomized, controlled trial. Anesth Analg. 2010; 110: 64-73.
• Flockton EA, Mastronardi P, Hunter JM, Gomar C, Mirakhur RK, Aguilera L, Giunta FG, Meistelman C, Prins ME. Reversal of rocuronium-induced neuromuscular block with sugammadex is faster than reversal of cisatracurium-induced block with neostigmine. Br J Anaesth. 2008; 100: 622-630.
• Lemmens HJ, El-Orbany MI, Berry J, Morte JB Jr, Martin G. Reversal of profound vecuronium-induced neuromuscular block under sevoflurane anesthesia: sugammadex versus neostigmine. BMC Anesthesiol. 2010; 10: 15.
• Rex C, Wagner S, Spies C, Scholz J, Rietbergen H, Heeringa M, Wulf H. Reversal of neuromuscular blockade by sugammadex after continuous infusion of rocuronium in patients randomized to sevoflurane or propofol maintenance anesthesia. Anesthesiology. 2009; 111: 30-35.
• Pühringer FK, Gordon M, Demeyer I, Sparr HJ, Ingimarsson J, Klarin B, van Duijnhoven W, Heeringa M. Sugammadex rapidly reverses moderate rocuronium- or vecuronium-induced neuromuscular block during sevoflurane anaesthesia: a doseresponse relationship. Br J Anaesth. 2010; 105: 610-619.