Sugammadex antagonism of rocuronium-induced neuromuscular blockade in patients with liver cirrhosis undergoing liver resection: a randomized controlled study

BACKGROUND: This randomized controlled study compared the recovery times of sugammadex and neostigmine as antagonists of moderate rocuronium-induced neuromuscular block in patients with liver cirrhosis and controls undergoing liver resection. METHODS: The study enrolled 27 adult patients with Child class "A" liver cirrhosis and 28 patients with normal liver functions. Normal patients and patients with liver cirrhosis were randomized according to the type of antagonist (sugammadex 2 mg/kg or neostigmine 50 µg/kg). The primary outcome was the time from antagonist administration to a train-of-four (TOF) ratio of 0.9 using mechanosensor neuromuscular transmission module. The durations of the intubating and top-up doses of rocuronium, the length of stay in the post-anesthesia care unit (PACU), and the incidence of postoperative re-curarization were recorded. RESULTS: The durations of the intubating and top-up doses of rocuronium were prolonged in patients with liver cirrhosis than controls. The times to a TOF ratio of 0.9 were 3.1 (1.0) and 2.6 (1.0) min after sugammadex administration in patients with liver cirrhosis and controls, respectively, P=1.00. The corresponding times after neostigmine administration were longer than sugammadex 14.5 (3.6) and 15.7 (3.6) min, respectively, P<0.001. The duration of PACU stay was shorter with the use of sugammadex compared to neostigmine. We did not encounter postoperative re-curarization after sugammadex or neostigmine. CONCLUSIONS: Sugammadex rapidly antagonize moderate residual rocuronium-induced neuromuscular block in patients with Child class "A" liver cirrhosis undergoing liver resection. Sugammadex antagonism is associated with 80% reduction in the time to adequate neuromuscular recovery compared to neostigmine.