Reversal of neuromuscular blockade with sugammadex during continuous administration of anaesthetic agents: a double‐blind randomised crossover study using the bispectral index
Summary 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 maint...
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| Veröffentlicht in: | Anaesthesia 2020-05, Vol.75 (5), p.583-590 |
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| creator | Le Guen, M. Roussel, C. Chazot, T. Dumont, G. A. Liu, N. Fischler, M. |
| description | Summary
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 |
| doi_str_mv | 10.1111/anae.14897 |
| format | Article |
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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.</description><identifier>ISSN: 0003-2409</identifier><identifier>EISSN: 1365-2044</identifier><identifier>DOI: 10.1111/anae.14897</identifier><identifier>PMID: 31808151</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>anaesthetic depth ; Anesthesia ; BIS values ; Double-blind studies ; Intravenous administration ; Muscles ; neuromuscular blockade ; Patients ; Randomization ; sugammadex ; Surgery</subject><ispartof>Anaesthesia, 2020-05, Vol.75 (5), p.583-590</ispartof><rights>2019 Association of Anaesthetists</rights><rights>2019 Association of Anaesthetists.</rights><rights>Copyright © 2020 Association of Anaesthetists</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3937-b72a8a62756b3df73053b0ec3d13ab0766019216b3985784cc32ad91724e519f3</citedby><cites>FETCH-LOGICAL-c3937-b72a8a62756b3df73053b0ec3d13ab0766019216b3985784cc32ad91724e519f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fanae.14897$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fanae.14897$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,1427,27903,27904,45553,45554,46388,46812</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31808151$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Le Guen, M.</creatorcontrib><creatorcontrib>Roussel, C.</creatorcontrib><creatorcontrib>Chazot, T.</creatorcontrib><creatorcontrib>Dumont, G. A.</creatorcontrib><creatorcontrib>Liu, N.</creatorcontrib><creatorcontrib>Fischler, M.</creatorcontrib><title>Reversal of neuromuscular blockade with sugammadex during continuous administration of anaesthetic agents: a double‐blind randomised crossover study using the bispectral index</title><title>Anaesthesia</title><addtitle>Anaesthesia</addtitle><description>Summary
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.</description><subject>anaesthetic depth</subject><subject>Anesthesia</subject><subject>BIS values</subject><subject>Double-blind studies</subject><subject>Intravenous administration</subject><subject>Muscles</subject><subject>neuromuscular blockade</subject><subject>Patients</subject><subject>Randomization</subject><subject>sugammadex</subject><subject>Surgery</subject><issn>0003-2409</issn><issn>1365-2044</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp9kUtuFDEQhi0EIpPAhgMgS2wQUgc_-uFmN4rCQ4pAQrBu-VE9cXDbg91OMjuOkCNwBo7AUTgJ7kxgwQJvLMufP_9VhdATSo5pWS-ll3BMa9F399CK8rapGKnr-2hFCOEVq0l_gA5TuiCEMkHFQ3TAqSCCNnSFfnyES4hJOhxG7CHHMOWks5MRKxf0F2kAX9n5HKe8kdNUjtfY5Gj9BuvgZ-tzyAlLM1lv0xzlbINfVEumNJ_DbDWWG_BzeoXlz-8mZOXg17cb5aw3OEpvwmQTGKxjSCmULDjN2exwTssfxYCVTVvQxe1weQPXj9CDUboEj-_2I_T59emnk7fV2Yc3707WZ5XmPe8q1TEpZMu6plXcjB0nDVcENDeUS0W6tiW0Z7Rc9qLpRK01Z9L0tGM1NLQf-RF6vvduY_iaSzVDSarBOemhFD0wzlhXl36Tgj77B70IOfqSrlBCtE3TsoV6sadua40wDttoJxl3AyXDMslh6dpwO8kCP71TZjWB-Yv-GV0B6B64sg52_1EN6_fr0730N4gLrnA</recordid><startdate>202005</startdate><enddate>202005</enddate><creator>Le Guen, M.</creator><creator>Roussel, C.</creator><creator>Chazot, T.</creator><creator>Dumont, G. A.</creator><creator>Liu, N.</creator><creator>Fischler, M.</creator><general>Blackwell Publishing Ltd</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7U7</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>202005</creationdate><title>Reversal of neuromuscular blockade with sugammadex during continuous administration of anaesthetic agents: a double‐blind randomised crossover study using the bispectral index</title><author>Le Guen, M. ; Roussel, C. ; Chazot, T. ; Dumont, G. A. ; Liu, N. ; Fischler, M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3937-b72a8a62756b3df73053b0ec3d13ab0766019216b3985784cc32ad91724e519f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>anaesthetic depth</topic><topic>Anesthesia</topic><topic>BIS values</topic><topic>Double-blind studies</topic><topic>Intravenous administration</topic><topic>Muscles</topic><topic>neuromuscular blockade</topic><topic>Patients</topic><topic>Randomization</topic><topic>sugammadex</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Le Guen, M.</creatorcontrib><creatorcontrib>Roussel, C.</creatorcontrib><creatorcontrib>Chazot, T.</creatorcontrib><creatorcontrib>Dumont, G. A.</creatorcontrib><creatorcontrib>Liu, N.</creatorcontrib><creatorcontrib>Fischler, M.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Anaesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Le Guen, M.</au><au>Roussel, C.</au><au>Chazot, T.</au><au>Dumont, G. A.</au><au>Liu, N.</au><au>Fischler, M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Reversal of neuromuscular blockade with sugammadex during continuous administration of anaesthetic agents: a double‐blind randomised crossover study using the bispectral index</atitle><jtitle>Anaesthesia</jtitle><addtitle>Anaesthesia</addtitle><date>2020-05</date><risdate>2020</risdate><volume>75</volume><issue>5</issue><spage>583</spage><epage>590</epage><pages>583-590</pages><issn>0003-2409</issn><eissn>1365-2044</eissn><abstract>Summary
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.</abstract><cop>England</cop><pub>Blackwell Publishing Ltd</pub><pmid>31808151</pmid><doi>10.1111/anae.14897</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | anaesthetic depth Anesthesia BIS values Double-blind studies Intravenous administration Muscles neuromuscular blockade Patients Randomization sugammadex Surgery |
| title | Reversal of neuromuscular blockade with sugammadex during continuous administration of anaesthetic agents: a double‐blind randomised crossover study using the bispectral index |
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