Reversal of rocuronium-induced neuromuscular block by sugammadex is independent of renal perfusion in anesthetized cats

• Published in: Journal of anesthesia Vol. 25; no. 2; pp. 241 - 246
• Main Authors: Staals, Lonneke M., de Boer, Hans D., van Egmond, Jan, Hope, Frank, van de Pol, Francien, Bom, Anton H., Driessen, Jacques J., Booij, Leo H. D. J.
• Format: Journal Article
• Language: English
• Published: Japan Springer Japan 01.04.2011; Springer
• Subjects: Analysis; Androstanols - pharmacology; Anesthesiology; Animals; Cats; Critical Care Medicine; Emergency Medicine; gamma-Cyclodextrins - pharmacology; Heart Rate - drug effects; Intensive; Male; Medicine; Medicine & Public Health; Neuromuscular Blockade; Neuromuscular blocking agents; Neuromuscular Nondepolarizing Agents - pharmacology; Original Article; Pain Medicine; Renal Circulation; Antagonism; Kidney failure; Sugammadex; Neuromuscular block; Rocuronium; Cat
• ISSN: 0913-8668; 1438-8359
• DOI: 10.1007/s00540-010-1090-3

Purpose Sugammadex is a selective relaxant binding agent designed to encapsulate the aminosteroidal neuromuscular blocking agent rocuronium, thereby reversing its effect. Both sugammadex and the sugammadex–rocuronium complex are eliminated by the kidneys. This study investigated the effect of sugammadex on recovery of rocuronium-induced neuromuscular block in cats with clamped renal pedicles, as a model for acute renal failure. Methods Twelve male cats were divided into two groups and anesthetized with medetomidine, ketamine, and alpha-chloralose. The cats were intubated and ventilated with a mixture of oxygen and air. Neuromuscular monitoring was performed by single twitch monitoring. Rocuronium 0.5 mg/kg i.v. was administered. After spontaneous recovery from neuromuscular block, both renal pedicles were ligated. A second dose of rocuronium 0.5 mg/kg i.v. was given. One minute after disappearance of the twitches, in Group 1 placebo (0.9% saline) and in Group 2 sugammadex 5.0 mg/kg i.v. was administered. Onset time, duration of neuromuscular block, and time to recovery to 25, 50, 75, and 90% were determined. Results After renal pedicle ligation, sugammadex reversed rocuronium-induced neuromuscular block significantly faster than spontaneous recovery. Mean time (SEM) to 90% recovery of the twitch response was 4.7 (0.25) min (Group 2) versus 31.1 (5.0) min (Group 1) ( p  < 0.0001). No signs of recurrence of neuromuscular block were observed for 90 min after complete twitch restoration. Sugammadex caused no significant cardiovascular effects. Conclusion Sugammadex rapidly and effectively reversed rocuronium-induced neuromuscular block in anesthetized cats, even when both renal pedicles were ligated and renal elimination of the drugs was no longer possible.