Sugammadex as Rescue Therapy

The time taken to achieve a TOF ratio of 0.9 after administration sugammadex

Neuromuscular blocking agents (NMBAs) are commonly used in the practice of anesthesiology for
 skeletal muscle relaxation to facilitate tracheal intubation, mechanical ventilation, and to
 provide optimal surgical conditions. In order to prevent residual NMB, it is vital to
 adequately reverse any use of a non-depolarizing NMBA. This was historically done using an
 anticholinesterase such as neostigmine, which would increase the concentration of
 acetylcholine at the neuromuscular junction leading to the return of neuromuscular
 transmission. Unfortunately, there are disadvantages to the use of an anticholinesterase. It
 was in this context that sugammadex was found to be a valuable addition to the
 anesthesiologist's armamentarium. It is a modified γ-cyclodextrin that encapsulates the
 aminosteroid NMBAs rocuronium and vecuronium.
 
 This project is a double-blind randomized placebo-controlled dose-response trial that aims to
 determine the time taken to achieve adequate reversal comparing five doses of sugammadex as
 rescue therapy following inadequate reversal with neostigmine. The study team will recruit
 patients aged 18 years and above from the main operating room and outpatient surgery center
 at Grady Memorial Hospital who are undergoing elective surgery under general anesthesia, who
 has received NMB, received neostigmine for NMB reversal, and achieved a TOF count ≥ 3
 twitches but not a TOF ratio of 0.9 fifteen minutes after neostigmine was given. Those with a
 TOF count 3 twitches will drop out of the study as there are already specified doses of
 sugammadex for that level of NMB