Abstract：
The dose of sugammadex recommended by the manufacturer for reversal of rocuronium is 2 mg/kg when the train-of-four count is 2 or more and 4 mg/kg when it is less than 2 but there is a posttetanic count of at least 1. The purpose of this dose-finding study was to titrate sugammadex to produce a train-of-four ratio 0.9 or greater at the conclusion of cardiac surgery, and to continue monitoring neuromuscular blockade in the intensive care unit to identify recurrent paralysis. The hypothesis was that many patients would require less than the recommended dose of sugammadex, but that some would require more, and that recurrent paralysis would not occur.
Neuromuscular blockade was monitored using electromyography during cardiac surgery. Administration of rocuronium was at the discretion of the anesthesia care team. During sternal closure, sugammadex was titrated in 50-mg increments every 5 min until a train-of-four ratio 0.9 or greater was obtained. Neuromuscular blockade was monitored with electromyography in the intensive care unit until sedation was discontinued before extubation or for a maximum of 7 h.
Ninety-seven patients were evaluated. The dose of sugammadex required to achieve a train-of-four ratio of 0.9 or greater varied from 0.43 to 5.6 mg/kg. There was a statistically significant relationship between the depth of neuromuscular blockade and the sugammadex dose required for reversal, but there was a large variation in dose required at any depth of neuromuscular blockade. Eighty-four of 97 patients (87%) required less than the recommended dose, and 13 (13%) required more. Two patients required additional sugammadex administration for recurrent paralysis.
When sugammadex was titrated to effect, the dose was usually less than the recommended dose, but it was more in some patients. Therefore, quantitative twitch monitoring is essential for ascertaining that adequate reversal has taken place after sugammadex administration. Recurrent paralysis was observed in two patients.
Neuromuscular blockade was monitored using electromyography during cardiac surgery. Administration of rocuronium was at the discretion of the anesthesia care team. During sternal closure, sugammadex was titrated in 50-mg increments every 5 min until a train-of-four ratio 0.9 or greater was obtained. Neuromuscular blockade was monitored with electromyography in the intensive care unit until sedation was discontinued before extubation or for a maximum of 7 h.
Ninety-seven patients were evaluated. The dose of sugammadex required to achieve a train-of-four ratio of 0.9 or greater varied from 0.43 to 5.6 mg/kg. There was a statistically significant relationship between the depth of neuromuscular blockade and the sugammadex dose required for reversal, but there was a large variation in dose required at any depth of neuromuscular blockade. Eighty-four of 97 patients (87%) required less than the recommended dose, and 13 (13%) required more. Two patients required additional sugammadex administration for recurrent paralysis.
When sugammadex was titrated to effect, the dose was usually less than the recommended dose, but it was more in some patients. Therefore, quantitative twitch monitoring is essential for ascertaining that adequate reversal has taken place after sugammadex administration. Recurrent paralysis was observed in two patients.
摘要：
背景:当四组计数为2或更大时,制造商推荐的用于逆转罗库溴铵的sugammadex的剂量为2mg/kg,当小于2但存在至少1的强直后计数时,为4mg/kg。这项剂量发现研究的目的是在心脏手术结束时滴定sugamadex以产生4个比率≥0.9，并继续监测ICU中的神经肌肉阻滞，以确定复发性瘫痪。假设是许多患者需要少于推荐剂量的sugammadex，但是有些人需要更多，这种反复发作的瘫痪不会发生.
方法：在心脏手术期间使用肌电图监测神经肌肉阻滞。罗库溴铵的给药由麻醉护理小组自行决定。在胸骨闭合期间，每5分钟以50mg的增量滴定sugammadex，直到获得4个比率≥0.9。在ICU中使用肌电图监测神经肌肉阻滞，直到在拔管前停止镇静或最多7小时。
结果：评估了97例患者。达到≥0.9的四组比例所需的sugammadex剂量在0.43至5.6mg/kg之间变化。神经肌肉阻滞的深度与逆转所需的Sugammadex剂量之间存在统计学上的显着关系，但是在任何深度的神经肌肉阻滞所需的剂量存在很大差异。97例患者中有84例（87％）需要低于推荐剂量，13（13％）需要更多。两名患者因复发性瘫痪而需要额外的sugammadex给药。
结论：当sugammadex滴定至有效时，剂量通常低于推荐剂量，但在一些病人身上更多.因此,定量抽搐监测对于确定sugammadex管理后已经发生了足够的逆转至关重要。2例患者出现复发性瘫痪。
方法：在心脏手术期间使用肌电图监测神经肌肉阻滞。罗库溴铵的给药由麻醉护理小组自行决定。在胸骨闭合期间，每5分钟以50mg的增量滴定sugammadex，直到获得4个比率≥0.9。在ICU中使用肌电图监测神经肌肉阻滞，直到在拔管前停止镇静或最多7小时。
结果：评估了97例患者。达到≥0.9的四组比例所需的sugammadex剂量在0.43至5.6mg/kg之间变化。神经肌肉阻滞的深度与逆转所需的Sugammadex剂量之间存在统计学上的显着关系，但是在任何深度的神经肌肉阻滞所需的剂量存在很大差异。97例患者中有84例（87％）需要低于推荐剂量，13（13％）需要更多。两名患者因复发性瘫痪而需要额外的sugammadex给药。
结论：当sugammadex滴定至有效时，剂量通常低于推荐剂量，但在一些病人身上更多.因此,定量抽搐监测对于确定sugammadex管理后已经发生了足够的逆转至关重要。2例患者出现复发性瘫痪。
