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SUGAMMADEX REVERSAL FOR INTRAOPERATIVE AND POSTOPERATIVE AWAKENING OF PATIENTS WITH REPEATED ADMINISTRATION OF ROCURONIUM IN SPINAL SURGERY


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Abstract

Objective: The aim of the study was a clinical analysis of sugammadex reversal of neuromuscular blockade induced by rocuronium during spinal corrective surgical procedures with intraoperative awakening test (“wake-up-test”), including the repeated administration of rocuronium after the reversal of the neuromuscular block. Methods. 48 patients aged 15-18 underwent posterior scoliosis correction with pedicle fixation. All of them received a planned intraoperative wake-up-test. Sugammadex was administered at a dose of 2 mg/kg, while TOFR was 1-2. We evaluated the reversal time and the patients’ starting to follow the instructions; afterwards rocuronium was re-administered at a dose of 0,6 mg/kg. Also assessed was the rate of awakening, re-falling asleep, repeated awakening and extubation, along with side effects. Results. Muscle response to TOF stimulation exceeded 90% in all the patients over 3 min after the first sugammadex injection at 2 mg/kg. The repeated administration of rocuronium after a complete reversal of NMB at a dose of 0,6 mg/kg (reduced two times as compared with the recommended 1,2 mg/kg) caused a complete re-NM block in all the patients over 2-5 min. After the surgery all of them were extubated in 1.2±0.08 min after the repeated sugammadex administration (TOF ≥ 90%). Conclusion: The use of sugammadex at a dose of 2 mg/kg (TOFR 1-2) in the protocol of intra- and postoperative awakening during spinal surgery is characterized by high clinical and economic efficiency, safety and the possibility of the repeated administration of rocuronium at a dose of 0.6 mg / kg.


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