Efficacy and safety of sugammadex in the reversal of deep neuromuscular blockade induced by rocuronium in patients with end-stage renal disease A comparative prospective clinical trial

BACKGROUNDRenal failure affects the pharmacology of nondepolarizing neuromuscular blockers making recovery of neuromuscular function unpredictable. Sugammadex antagonises rocuronium-induced neuromuscular blockade by encapsulating rocuronium, creating a stable complex molecule that is mainly excreted by the kidneys. Previous studies suggest that sugammadex is effective in reversing moderate neuromuscular block in the presence of renal failure, but no data are available regarding reversal of profound neuromuscular block in patients with renal failure.OBJECTIVEThe objective of this study is to compare the efficacy and safety of sugammadex in reversing profound neuromuscular block induced by rocuronium in patients with end-stage renal disease and those with normal renal function.DESIGNA prospective clinical trial.SETTINGTwo university hospitals, from 1 October 2011 to 31 January 2012.PATIENTSForty patients undergoing kidney transplant: 20 with renal failure [creatinine clearance (ClCr) <30mlmin(-1)] and 20 control patients (ClCr >90mlmin(-1)).INTERVENTIONNeuromuscular monitoring was performed by acceleromyography and train-of-four (TOF) stimulation. Profound neuromuscular block (posttetanic count, one to three responses) was maintained during surgery. Sugammadex 4mgkg(-1) was administered on completion of skin closure. Recovery of the TOF ratio to 0.9 was recorded. Monitoring of neuromuscular function continued in the postanesthesia care unit for a further 2h.MAIN OUTCOME MEASURESThe efficacy of sugammadex was evaluated by the time taken for the TOF ratio to recover to 0.9. The safety of sugammadex was assessed by monitoring for recurrence of neuromuscular block every 15min for 2h. Secondary variables were time to recovery of TOF ratio to 0.7 and 0.8.RESULTSAfter sugammadex administration, the mean time for recovery of the TOF ratio to 0.9 was prolonged in the renal failure group (5.63.6min) compared with the control group (2.71.3min, P=0.003). No adverse events or evidence of recurrence of neuromuscular block were observed.CONCLUSIONIn patients with renal failure, sugammadex (4mgkg(-1)) effectively and safely reversed profound rocuronium induced neuromuscular block, but the recovery was slower than healthy patients.TRIAL REGISTRATIONClinicaltrials.gov identifier NCT01785758.