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Elderly Patients Require Higher Doses of Sugammadex for Rapid Recovery from Deep Neuromuscular Block.

 Seokyung Shin  ;  Dong Woo Han  ;  Hye Sun Lee  ;  Mi Kyung Song  ;  Eun-kyung Jun  ;  So Yeon Kim 
 Basic & Clinical Pharmacology & Toxicology, Vol.118(6) : 462-467, 2016 
Journal Title
 Basic & Clinical Pharmacology & Toxicology 
Issue Date
Adult ; Age Factors ; Aged ; Aged, 80 and over ; Androstanols/administration & dosage* ; Anesthesia Recovery Period ; Dose-Response Relationship, Drug ; Female ; Humans ; Male ; Neuromuscular Blockade* ; Neuromuscular Nondepolarizing Agents/administration & dosage* ; Republic of Korea ; Young Adult ; gamma-Cyclodextrins/administration & dosage ; gamma-Cyclodextrins/pharmacology*
This study compared the doses of sugammadex needed for rapid recovery from deep neuromuscular blockade (NMB) between young and elderly adults. Twenty-two young (20-40 yrs) and 22 elderly (≥70 yrs) adults were enrolled, and deep NMB of 1-2 post-tetanic counts was maintained with rocuronium intraoperatively. Predetermined doses of sugammadex were given at the end of surgery starting at 4.0 mg/kg for the first patient of each group. Doses were decreased or increased in following patients by 0.5 mg/kg, depending on the 'success' or 'failure' of rapid recovery in the preceding patient. 'Success' was defined as adequate recovery (train-of-four ratio 0.9) within 2 min. after sugammadex administration. The median (range) of ages was 29 (20-40) and 73 (70-84) yrs for the young and elderly adults, respectively. Doses of sugammadex facilitating adequate recovery from deep NMB within 2 min. in each patient population with 50% and 95% probability were defined as ED50 and ED95 , respectively. The ED50 estimated by the Dixon's method was significantly higher in the elderly compared to young adults [4.2 ± 0.4 mg/kg versus 3.3 ± 0.3 mg/kg, p < 0.001]. The ED50 (83% CI) estimated by isotonic regression was 4.5 (4.2-5.0) mg/kg in elderly adults and 3.3 (3.2-3.4) mg/kg in young adults. The ED95 (95% CI) estimated by isotonic regression was 5.4 (4.9-5.5) mg/kg and 4.4 (3.9-4.5) mg/kg in the elderly and young adults, respectively. In conclusion, dose adjustments of sugammadex should be considered when rapid recovery from deep NMB is needed in elderly adults.
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
김소연(Kim, So Yeon) ORCID logo https://orcid.org/0000-0001-5352-157X
신서경(Shin, Seokyung) ORCID logo https://orcid.org/0000-0002-2641-0070
이혜선(Lee, Hye Sun) ORCID logo https://orcid.org/0000-0001-6328-6948
전은경(Jun, Eun kyung)
한동우(Han, Dong Woo) ORCID logo https://orcid.org/0000-0002-8757-663X
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