Journal of Anesthesia

, Volume 25, Issue 2, pp 286–290 | Cite as

Use of rocuronium–sugammadex, an alternative to succinylcholine, as a muscle relaxant during electroconvulsive therapy

  • Hiroko Hoshi
  • Yuji KadoiEmail author
  • Jiro Kamiyama
  • Akiko Nishida
  • Hiroyuki Saito
  • Masaki Taguchi
  • Shigeru Saito
Clinical Report


We compared the recovery time from neuromuscular blockade induced by rocuronium combined with sugammadex versus succinylcholine during electroconvulsive therapy (ECT). Anesthesia was induced using propofol, followed by succinylcholine (1 mg/kg) or rocuronium (0.6 mg/kg). Immediately after the seizure stopped, 16 mg/kg sugammadex was infused. Neuromuscular monitoring was performed and continued until recovery of the train-of-four ratio to 0.9. We compared the recovery time of T1 to 10 and 90% between groups. Patients were also assessed for clinical signs, such as time to first spontaneous breath from the administration of muscle relaxant and eye opening to verbal commands. Although recovery time of T1 to 10 and 90% in the rocuronium–sugammadex group was shorter than in the succinylcholine group, the difference was not statistically significant. Further, the seizure duration with succinylcholine (33 ± 8 s) was shorter than that with rocuronium–sugammadex (39 ± 4 s). In conclusion, this study demonstrates the potential benefit of use of rocuronium–sugammadex as an alternative to succinylcholine for muscle relaxation during ECT.


Electroconvulsive therapy Muscle relaxant Rocuronium Sugammadex Succinylcholine 


Conflict of interest



  1. 1.
    Kadoi Y, Saito S. Anesthetic considerations for electroconvulsive therapy—especially hemodynamic and respiratory management. Curr Psychiatr Rev. 2009;5:276–86.CrossRefGoogle Scholar
  2. 2.
    Lee C, Jahr JS, Candiotti KA, Warriner B, Zornow MH, Naguib M. Reversal of profound neuromuscular block by sugammadex administered three minutes after rocuronium: a comparison with spontaneous recovery from succinylcholine. Anesthesiology. 2009;110:1020–5.PubMedCrossRefGoogle Scholar
  3. 3.
    Lee C. Goodbye suxamethonium!. Anaesthesia. 2009;64:73–81.PubMedCrossRefGoogle Scholar
  4. 4.
    Cheam EW, Critchley LA, Chui PT, Yap JC, Ha VW. Low dose mivacurium is less effective than succinylcholine in electroconvulsive therapy. Can J Anesth. 1999;46:49–51.PubMedCrossRefGoogle Scholar
  5. 5.
    Turkkal DC, Gokmen N, Yildiz A, Iyilikci L, Gokel E, Sagduyu K, Gunerli A. A cross-over, post-electroconvulsive therapy comparison of clinical recovery from rocuronium versus succinylcholine. J Clin Anesth. 2008;20:589–93.PubMedCrossRefGoogle Scholar
  6. 6.
    Kadar AG, Kramer BA, Barth MC, White PF. Rapacuronium: an alternative to succinylcholine for electroconvulsive therapy. Anesth Analg. 2001;92:1171–2.PubMedCrossRefGoogle Scholar
  7. 7.
    Janis K, Hess J, Fabian JA, Gillis M. Substitution of mivacurium for succinylcholine for ECT in elderly patients. Can J Anesth. 1995;42:612–3.PubMedCrossRefGoogle Scholar
  8. 8.
    Trollor JN, Sachdev PS. Electroconvulsive treatment of neuroleptic malignant syndrome: a review and report of cases. Aust N Z J Psychiatry. 1999;33:650–9.PubMedGoogle Scholar
  9. 9.
    Nishiyama M, Togashi H. Effects of anesthetic agents on seizure duration and hemodynamics in electroconvulsive therapy (in Japanese with English abstract). Masui (Jpn J Anesthesiol). 2009;58:1266–9.Google Scholar
  10. 10.
    Setoyama K, Hirata T, Saeki H, Morimoto Y, Tsuruta S, Matsumoto M, Sakabe T. Anesthetic management for electroconvulsive therapy in the patients with a history of neuroleptic malignant syndrome (in Japanese with English abstract). Masui (Jpn J Anesthesiol). 2009;58:633–6.Google Scholar
  11. 11.
    Kelly D, Brull SJ. Neuroleptic malignant syndrome and mivacurium: a safe alternative to succinylcholine? Can J Anaesth. 1994;41:845–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Pühringer FK, Rex C, Sielenkämper AW, Claudius C, Larsen PB, Prins ME, Eikermann M, Khuenl-Brady KS. Reversal of profound, high-dose rocuronium-induced neuromuscular blockade by sugammadex at two different time points: an international, multicenter, randomized, dose-finding, safety assessor-blinded, phase II trial. Anesthesiology. 2008;109:188–97.PubMedCrossRefGoogle Scholar
  13. 13.
    Matsumoto N, Tomioka A, Sato T, Kawasaki M, Kadoi Y, Saito S. Relationship between cardiac output and onset of succinylcholine chloride action in electroconvulsive therapy patients. J ECT. 2009;25:246–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Duvaldestin P, Kuizenga K, Saldien V, Claudius C, Servin F, Klein J, Debaene B, Heeringa M. A randomized, dose-response study of sugammadex given for the reversal of deep rocuronium- or vecuronium-induced neuromuscular blockade under sevoflurane anesthesia. Anesth Analg. 2010;110:74–82.PubMedCrossRefGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2011

Authors and Affiliations

  • Hiroko Hoshi
    • 1
  • Yuji Kadoi
    • 1
    Email author
  • Jiro Kamiyama
    • 1
  • Akiko Nishida
    • 1
  • Hiroyuki Saito
    • 1
  • Masaki Taguchi
    • 1
  • Shigeru Saito
    • 1
  1. 1.Department of AnesthesiologyGunma University, School of MedicineMaebashiJapan

Personalised recommendations