• Seokyung Shin, Dong Woo Han, Hye Sun Lee, Mi Kyung Song, Eun-Kyung Jun, and So Yeon Kim.
• Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
• Basic Clin. Pharmacol. Toxicol. 2016 Jun 1; 118 (6): 462-7.

AbstractThis study compared the doses of sugammadex needed for rapid recovery from deep neuromuscular blockade (NMB) between young and elderly adults. Twenty-two young (20-40 yrs) and 22 elderly (≥70 yrs) adults were enrolled, and deep NMB of 1-2 post-tetanic counts was maintained with rocuronium intraoperatively. Predetermined doses of sugammadex were given at the end of surgery starting at 4.0 mg/kg for the first patient of each group. Doses were decreased or increased in following patients by 0.5 mg/kg, depending on the 'success' or 'failure' of rapid recovery in the preceding patient. 'Success' was defined as adequate recovery (train-of-four ratio 0.9) within 2 min. after sugammadex administration. The median (range) of ages was 29 (20-40) and 73 (70-84) yrs for the young and elderly adults, respectively. Doses of sugammadex facilitating adequate recovery from deep NMB within 2 min. in each patient population with 50% and 95% probability were defined as ED50 and ED95 , respectively. The ED50 estimated by the Dixon's method was significantly higher in the elderly compared to young adults [4.2 ± 0.4 mg/kg versus 3.3 ± 0.3 mg/kg, p < 0.001]. The ED50 (83% CI) estimated by isotonic regression was 4.5 (4.2-5.0) mg/kg in elderly adults and 3.3 (3.2-3.4) mg/kg in young adults. The ED95 (95% CI) estimated by isotonic regression was 5.4 (4.9-5.5) mg/kg and 4.4 (3.9-4.5) mg/kg in the elderly and young adults, respectively. In conclusion, dose adjustments of sugammadex should be considered when rapid recovery from deep NMB is needed in elderly adults.© 2015 Nordic Association for the Publication of BCPT (former Nordic Pharmacological Society).

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