Sugammadex Dosing: Anaesthesiologist Clinical Perception Versus Quantitative Monitoring
Condition: Neuromuscular Blockade; Anesthesia; TOF; Curarization, Postoperative Residual
MeSH terms: Delayed Emergence from Anesthesia
Study type: Observational

Summary: 
      Many clinicians continue to rely on subjective evaluation in making decisions about the
      adequacy of neuromuscular function before tracheal extubation rather than using quantitative
      monitoring. The aim was to compare the sugammadex dose as suggested by senior
      anaesthesiologists (SSD) based on clinical experience versus the dose determined by
      quantitative monitoring (QSD) to determine if the subjective dose was appropriate.
    

Detailed description: 
      Materials and Methods:

      After obtaining approval from the Institute Ethics Committee, a prospective 3-month study in
      patients aged 18-75 years who underwent general anesthesia with rocuronium (initial dose 0.6
      mg/kg) NMB and subsequent reversal with sugammadex, was carried out. American Society of
      Anesthesiologists (ASA ) physical status V, emergency surgery, patients with hypersensitivity
      history to rocuronium or sugammadex, severe renal impairment/dialysis, neuromuscular
      diseases, severe hepatic disease, pre-existing coagulopathies and pregnancy were excluded.
      Monitoring included ASA standard monitoring, bispectral index and NMB monitoring using
      TOFscan® monitor. The senior anaesthesiologist was blinded to the TOFscan®, which was only
      available to the author.

      At the time of pharmacologic reversal of NMB, both the sugammadex dose proposed by the
      anaesthesiologist (SSD) and the dose suggested by TOFscan® (QSD) according to the Portuguese
      recommendations for the management of NMB were recorded. Afterwards the QSD was administered
      to overcome ethical issues. When train-of-four (TOF) count was 0, the author performed the
      post tetanic count (PTC) stimulus to determine the recommended dose. The SSD was considered
      appropriate if it was within 10% of the QSD for the depth of NMB. All patients were extubated
      with a TOF ratio > 0.9 (TOFr) and both the rocuronium and sugammadex dose were calculated
      based on the real patient weight. Data regarding anaesthesia, duration of anaesthesia and
      dosing pattern of rocuronium were also noted. The results were analysed descriptively.
    

Intervention name(s): Dose of sugammadex according to SSD and QSD
Intervention type(s): Other
Intervention description(s): At the time of pharmacologic reversal of the NMB, both the SSD and QSD, according to portuguese guidelines on the management of the NMB, were recorded. The QSD was then administered to the patient. The SSD was considered appropriate if it was within 10% of the recommended dose for the given depth of NMB, as measured by TOFscan® monitor. The results were analyzed descriptively.
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Population was made of 66 individuals, aged 18-75 years who underwent general anesthesia
        with rocuronium (initial dose 0.6 mg/kg) neuromuscular blockade and subsequent reversal
        with sugammadex.