Method for Prediction of Efficacy of Sugammadex Administered to Recover from Rocuronium-Induced Neuromuscular Blockade in Gynecological Laparoscopic Surgery Cases

• Published in: Biological & pharmaceutical bulletin 2018/03/01, Vol.41(3), pp.312-318
• Main Authors: Kimura, Koji, Omura, Kazuya, Hoshino, Tetsuya, Takahashi, Hiroyuki, Imaura, Masaharu, Yamada, Yasuhiko
• Format: Article
• Language: English
• Subjects: Bilirubin; Body weight; Creatinine; Dosage; gynecological laparoscopic surgery; Laparoscopy; Multiple regression analysis; Patients; Regression analysis; reverse time prediction; rocuronium; sugammadex; Surgery
• ISSN: 0918-6158; 1347-5215
• DOI: 10.1248/bpb.b17-00304

Sugammadex (SDX), a neuromuscular blocking-reversal agent, quickly reverses neuromuscular blockade induced by rocuronium (RCR). SDX dosage is set according to the state of neuromuscular blockade determined with a neuromuscular monitoring device. However, in clinical situations, such a devise is not frequently used. Here, we report construction of a method for theoretically setting SDX dose by which the optimum reverse time (RT) can be obtained for individual patients even when the device is not available. The subjects were 42 adult female patients who underwent laparoscopic surgery from 1 August 2015 to 31 March 2016, during which RCR and SDX were administered. We formulated an equation for theoretically calculating the RCR residual ratio (RR) in blood after SDX administration. Furthermore, we examined the relationship between RR and RT. Based on the results obtained, we developed a method for predicting RT using RR. We excluded 1 subject as the RT value was detected as an outlier in our analysis. Multiple regression analysis was performed using standard body weight, serum creatinine, total bilirubin, and RR as explanatory variables. The number of subjects with a prediction error of RT within ±1 min was 36 (87.8%) of 41 in multiple regression analysis. We could predict RT following SDX administration by using the RT prediction expression with RR obtained for subjects administered RCR during the surgery. Furthermore, our results suggest that the SDX dose able to achieve optimum RT may be set prior to surgery on the basis of the present methodology.