Effects of sugammadex on deep neuromuscular blockade reversal in laparoscopic colorectal resection: a prospective observational study

Background & objective: Sugammadex can provide a rapid recovery from deep neuromuscular blockade induced by aminosteroid non-depolarizing paralytics and has recently been recommended as a routine reversal agent for neuromuscular blockade induced by rocuronium or vecuronium. This study aims to investigate the efficacy and safety of sugammadex on the reversal of rocuronium-induced deep neuromuscular blockade in patients undergoing laparoscopic colorectal resection. Methodology: This was a prospective observational study on 59 patients who had scheduled laparoscopic colorectal resection surgery in a national teaching hospital in Vietnam. The primary outcome was the time to reach a train-of-four ratio of 0.9. Secondary outcomes included the incidence of deep neuromuscular blockade at the end of the surgery and the incidence of residual neuromuscular blockade in the post-anesthesia care unit (PACU). Results: The average time to reach a train-of-four (TOF) ratio of 0.9 was 4.0 min (ranging from 1.5 to 8.9 min). It took 4.2 min and 3.7 min to fully recover of neuromuscular function in the 4 mg/kg and the 2 mg/kg groups, respectively. At the end of the surgery, 62.7% of patients remained under a deep level of neuromuscular blockade. There was no incidence of residual paralysis recorded in the PACU. Older age and higher ASA classification appeared to be associated with prolonged time to reach a TOF ratio of 0.9 following reversal by sugammadex. Conclusions: Sugammadex provided a rapid recovery from deep blockade induced by rocuronium in laparoscopic colorectal resection patients and there was no event of residual blockade in the PACU. Keywords: Sugammadex; Deep Neuromuscular Blockade; Laparoscopic Colorectal Resection; Residual Neuromuscular Blockade Citation: Phan VTN, Nguyen DT, Phi HT. Effects of sugammadex on deep neuromuscular blockade reversal in laparoscopic colorectal resection: a prospective observational study. Anaesth. pain intensive care 2025;29(2):194-201. DOI: 10.35975/apic.v29i2.2703 Received: July 30, 2024; Reviewed: October 26, 2024; Accepted: February 04, 2025