Perioperative Medicine  |   November 2018
Differences of Recovery from Rocuronium-induced Deep Paralysis in Response to Small Doses of Sugammadex between Elderly and Nonelderly Patients
Author Notes
  • From the Department of Anesthesiology, Chiba University Hospital, Chiba, Japan (T.M., N.N.-T., Y.K.); the Department of Anesthesiology (S.I., T.I., J.O.) and Department of Global Clinical Research (Y.S.), Graduate School of Medicine, Chiba University, Chiba, Japan; and the Department of Anesthesiology, Kimitsu Chuo Hospital, Kisarazu, Japan (N.M.).
  • This work was presented at the European Society of Anaesthesiologists Annual Meeting in Copenhagen, Denmark, June 3, 2018, as “Elderly Patients Are One of the High-risk Groups of Recurarization Due to Insufficient Dose of Sugammadex.” This work is attributed to the Department of Anesthesiology, Graduate School of Medicine, Chiba University, Chiba, Japan.
    This work was presented at the European Society of Anaesthesiologists Annual Meeting in Copenhagen, Denmark, June 3, 2018, as “Elderly Patients Are One of the High-risk Groups of Recurarization Due to Insufficient Dose of Sugammadex.” This work is attributed to the Department of Anesthesiology, Graduate School of Medicine, Chiba University, Chiba, Japan.×
  • Submitted for publication December 12, 2017. Accepted for publication July 20, 2018.
    Submitted for publication December 12, 2017. Accepted for publication July 20, 2018.×
  • Address correspondence to Dr. Isono: Department of Anesthesiology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana-cho, Chuo-ku, Chiba, 260–8670, Japan. shirohisono@yahoo.co.jp. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Clinical Science / Central and Peripheral Nervous Systems / Geriatric Anesthesia / Neuromuscular Diseases and Drugs / Pharmacology
Perioperative Medicine   |   November 2018
Differences of Recovery from Rocuronium-induced Deep Paralysis in Response to Small Doses of Sugammadex between Elderly and Nonelderly Patients
Anesthesiology 11 2018, Vol.129, 901-911. doi:10.1097/ALN.0000000000002412
Anesthesiology 11 2018, Vol.129, 901-911. doi:10.1097/ALN.0000000000002412
Abstract

Editor’s Perspective:

What We Already Know about This Topic:

  • Sugammadex may be the best available drug to reverse residual neuromuscular blockade produced by rocuronium and vecuronium

  • A 5% incidence of residual neuromuscular blockade has been reported after administering sugammadex without neuromuscular monitoring

  • Elderly patients have been reported to respond differently than nonelderly patients do to rocuronium and sugammadex

What This Article Tells Us That Is New:

  • The train-of-four ratio recovery rate after low-dose sugammadex administration was slower in elderly patients than it was in nonelderly patients

  • Recurarization after low-dose sugammadex administration occurred more frequently in elderly patients than in nonelderly patients

  • Slower spontaneous train-of-four ratio recovery and impaired renal function were most closely associated with the decreased train-of-four ratio change rate in response to low-dose sugammadex in multiple linear regression analysis

Background: Complete recovery from rocuronium-induced muscle paralysis with sugammadex is reported to be delayed in elderly patients. The authors tested a hypothesis that recovery from deep neuromuscular block with low-dose sugammadex is slower (primary hypothesis) and incidence of recurarization is higher (secondary hypothesis) in elderly patients than in nonelderly patients.

Methods: In anesthetized elderly (n = 20; 76.9 ± 5.0 yr of age) and nonelderly patients (n = 20; 53.7 ± 12.8 yr of age) under deep paralysis with rocuronium, change of train-of-four ratio per minute (primary outcome variable) was measured with an acceleromyograph neuromuscular monitor during spontaneous recovery from rocuronium-induced muscle paralysis (0.6 mg/kg) and after infusion of low-dose sugammadex (50 µg · kg-1 · min-1). Recurarization was defined as the negative change of train-of-four ratio.

Results: Spontaneous train-of-four ratio recovery rate was significantly slower in the elderly group (median [25th percentile, 75th percentile]: 1.89 [1.22, 2.90] %/min) than in the nonelderly group (3.45 [1.96, 4.25] %/min, P = 0.024). Train-of-four ratio change rate in response to low-dose sugammadex was significantly slower in elderly (0.55 [–0.29, 1.54] %/min) than in the nonelderly group (1.68 [0.73, 3.13] %/min, P = 0.024). Incidence of recurarization was significantly higher in the elderly group than in the nonelderly group (35% vs. 5%, P = 0.044). Multiple linear regression analyses indicate that slower spontaneous train-of-four ratio recovery rate and impaired renal function are two major contributing factors that decrease train-of-four ratio change rate in response to low-dose sugammadex.

Conclusions: Elderly patients are at greater risk for recurarization and residual muscle paralysis when low-dose sugammadex is administered.