In the current issue of Anesthesiology, Bowdle et al.1 report the results of an observational study examining the dose of sugammadex required to achieve adequate reversal of a rocuronium neuromuscular block in a group of elective cardiac surgical patients. At the end of surgery, the authors gave 97 patients small (50 mg), repeated (every 5 min) incremental doses of sugammadex until a train-of-four ratio of 0.90 or greater was achieved and then continued to monitor the train-of-four ratio for up to 7 h postoperatively. This work contains a number of findings that deserve attention from our entire profession. Most importantly, it contradicts the widespread belief that simply giving the recommended 2- or 4-mg/kg dose of sugammadex, based solely on an observed twitch count (or post-tetanic count) ensures adequate reversal. While we have no objections to these recommended (and Food and Drug Administration–approved) doses, the Bowdle et al.1...
Sugammadex Is Not a Silver Bullet: Caveats Regarding Unmonitored Reversal
Accepted for publication April 11, 2023.
This editorial accompanies the article on p. 6.
Michael M. Todd, Aaron F. Kopman; Sugammadex Is Not a Silver Bullet: Caveats Regarding Unmonitored Reversal. Anesthesiology 2023; 139:1–3 doi: https://doi.org/10.1097/ALN.0000000000004587
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