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

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Abstract

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.

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Acknowledgments

This work was supported by a grant from Merck, Sharp & Dohme BV (formerly Organon NV), Oss, The Netherlands.

Conflict of interest

LM Staals received travel fees from MSD. HD De Boer received speaker fees from MSD. AH Bom is employed by MSD and holds stocks in MSD. F Hope was employed by MSD. LHDJ Booij was a member of the scientific advisory board of MSD and received speaker fees from MSD. J van Egmond, F van de Pol and J Driessen do not have conflicts of interest.

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Authors and Affiliations

  1. Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

    Lonneke M. Staals, Jan van Egmond, Francien van de Pol, Jacques J. Driessen & Leo H. D. J. Booij

  2. Department of Anesthesiology, Erasmus University Medical Centre, Sophia Children’s Hospital, Sb 3060, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands

    Lonneke M. Staals

  3. Department of Anesthesiology and Pain Medicine, Martini General Hospital, Groningen, The Netherlands

    Hans D. de Boer

  4. Department of Pharmacology, Organon Newhouse, a part of Merck, Sharp and Dohme, ML1 5SH, Lanarkshire, Scotland, UK

    Frank Hope & Anton H. Bom

Authors
  1. Lonneke M. Staals
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  2. Hans D. de Boer
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  3. Jan van Egmond
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  4. Frank Hope
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  5. Francien van de Pol
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  6. Anton H. Bom
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  7. Jacques J. Driessen
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  8. Leo H. D. J. Booij
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Corresponding author

Correspondence to Lonneke M. Staals.

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Staals, L.M., de Boer, H.D., van Egmond, J. et al. Reversal of rocuronium-induced neuromuscular block by sugammadex is independent of renal perfusion in anesthetized cats. J Anesth 25, 241–246 (2011). https://doi.org/10.1007/s00540-010-1090-3

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  • DOI: https://doi.org/10.1007/s00540-010-1090-3

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