Reversal of rocuronium-induced neuromuscular block with sugammadex in heart failure patients : a prospective observational study

The aim of this study was to assess the hemodynamic stability and efficacy of 2 mg/kg sugammadex in reversing rocuronium-induced neuromuscular block in patients with heart failure. Twelve patients who had an ejection fraction <= 25% and who were undergoing general anesthesia for cardiac resynchronization therapy, an automated implantable cardioverter-defibrillator, or battery replacement of the device were included. Neuromuscular function was monitored by acceleromyography of the adductor pollicis muscle. Each patient received 0.6 mg/kg of rocuronium and maintenance doses of 0.1 mg/kg when required. When the second twitch appeared at the end of surgery, the patients received 2 mg/kg sugammadex. After the administration of sugammadex, the time for recovery to a normalized train-of-four (TOF) ratio of 0.9 was 2.78 +/- 0.67 min. Blood pressure and heart rate remained stable up to 10 min after the administration of sugammadex and then increased by the 30-min assessment. Three patients had episodes of SpO(2)< 90% in the postanesthesia care unit. No sugammadex-related adverse events were reported. Sugammadex can adequately restore neuromuscular function in heart failure patients under hemodynamically stable conditions. However, longer reversal times are required than previously observed in healthy, young patients.