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MINERVA ANESTESIOLOGICA

Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva


Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
Indexed/Abstracted in: Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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Minerva Anestesiologica 2018 Feb 05

DOI: 10.23736/S0375-9393.18.12217-6

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Sugammadex antagonism of rocuronium-induced neuromuscular blockade in patients with liver cirrhosis undergoing liver resection: a randomized controlled study

Mohamed ABDULATIF 1 , Maha LOTFY 2, Mahmoud MOUSA 2, Mohamed H. AFIFI 3, Khaled YASSEN 2

1 Anesthesiology Department, Faculty of Medicine, Cairo University, Cairo, Egypt; 2 National Liver Institute, Menoufiya University, Menoufiya, Egypt; 3 Faculty of Medicine, Menoufiya University, Menoufiya, Egypt


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BACKGROUND: This randomized controlled study compared the recovery times of sugammadex and neostigmine as antagonists of moderate rocuroniuminduced neuromuscular block in patients with liver cirrhosis and controls undergoing liver resection.
METHODS: The study enrolled 27 adult patients with Child class “A” liver cirrhosis and 28 patients with normal liver functions. Normal patients and patients with liver cirrhosis were randomized according to the type of antagonist (sugammadex 2mg/kg or neostigmine 50μg/kg). The primary outcome was the time from antagonist administration to a trainoffour (TOF) ratio of 0.9 using mechanosensor neuromuscular transmission module. The durations of the intubating and topup doses of rocuronium, the length of stay in the postanesthesia care unit (PACU), and the incidence of postoperative re curarization were recorded.
RESULTS: The durations of the intubating and topup doses of rocuronium were prolonged in patients with liver cirrhosis than controls. The times to a TOF ratio of 0.9 were 3.1 (1.0) and 2.6 (1.0) min after sugammadex administration in patients with liver cirrhosis and controls, respectively, p=1.00. The corresponding times after neostigmine administration were longer than sugammadex 14.5 (3.6) and 15.7 (3.6) min, respectively, p<0.001. The duration of PACU stay was shorter with the use of sugammadex compared to neostigmine. We did not encounter postoperative recurarization after sugammadex or neostigmine.
CONCLUSIONS: Sugammadex rapidly antagonize moderate residual rocuronium induced neuromuscular block in patients with Child class “A” liver cirrhosis undergoing liver resection. Sugammadex antagonism is associated with 80% reduction in the time to adequate neuromuscular recovery compared to neostigmine.


KEY WORDS: Neuromuscular blockers, rocuronium - Neuromuscular antagonist, sugammadex - Complication, liver cirrhosis

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Publication History

Article first published online: February 05, 2018
Manuscript accepted: January 26, 2018
Manuscript revised: January 16, 2018
Manuscript received: June 3, 2017

Per citare questo articolo

Abdulatif M, Lotfy M, Mousa M, Afifi MH, Yassen K. Sugammadex antagonism of rocuronium-induced neuromuscular blockade in patients with liver cirrhosis undergoing liver resection: a randomized controlled study. Minerva Anestesiol 2018 Feb 05. DOI: 10.23736/S0375-9393.18.12217-6

Corresponding author e-mail

mohamedabdulatif53@gmail.com