Recovery Profile of Rocuronium-Induced Muscle Relaxation and Its Practical Reverse

Abstract

 Rocuronium blomide is a steroidal neuromuscular blocking agent with rapid onset and intermediate duration and a neuromuscular blockade that is potentiated by volatile anesthetics. Postoperative residual curarization is a potentially lethal complication of anesthesia and its presence has been confirmed by some studies even when intermediate neuromuscular blocking agents have been used. Residual neuromuscular blockade can be antagonized by anticholinesterases, but these have their own side effects, such as bradycardia, postoperative nausea and vomiting. This, in turn, requires cholinergic antagonists. Caution should be taken for the timing of reversal agents and quantitative evaluation is recommended to avoid residual paralysis in postanesthetic care unit. The train-of-four ratio (TOFR) at the adductor pollicis required to avoid residual paralysis is now considered to be at least 0.9.
 Sugammadex is a modified cyclodextrin designed to encapsulate aminosteroidal non-depolarizing muscle relaxants within its lipophilic core which is no longer available to bind with the acetylcholine receptor. It has been shown to be safe and effective in humans. Its rapid reversal of blockade makes it possible to keep patients profoundly muscle-relaxed during the induction and maintenance of anesthesia, and it can improve patient safety.