• Takahiro Muramatsu, Shiroh Isono, Teruhiko Ishikawa, Natsuko Nozaki-Taguchi, Junko Okazaki, Yuji Kitamura, Noriko Murakami, and Yasunori Sato.
• From the Department of Anesthesiology, Chiba University Hospital, Chiba, Japan (T.M., N.N.-T., Y.K.) the Department of Anesthesiology (S.I., T.I., J.O.) Department of Global Clinical Research (Y.S.), Graduate School of Medicine, Chiba University, Chiba, Japan the Department of Anesthesiology, Kimitsu Chuo Hospital, Kisarazu, Japan (N.M.).
• Anesthesiology. 2018 Nov 1; 129 (5): 901-911.

What We Already Know About This TopicWHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Complete recovery from rocuronium-induced muscle paralysis with sugammadex is reported to be delayed in elderly patients. The authors tested a hypothesis that recovery from deep neuromuscular block with low-dose sugammadex is slower (primary hypothesis) and incidence of recurarization is higher (secondary hypothesis) in elderly patients than in nonelderly patients.MethodsIn anesthetized elderly (n = 20; 76.9 ± 5.0 yr of age) and nonelderly patients (n = 20; 53.7 ± 12.8 yr of age) under deep paralysis with rocuronium, change of train-of-four ratio per minute (primary outcome variable) was measured with an acceleromyograph neuromuscular monitor during spontaneous recovery from rocuronium-induced muscle paralysis (0.6 mg/kg) and after infusion of low-dose sugammadex (50 µg · kg · min). Recurarization was defined as the negative change of train-of-four ratio.ResultsSpontaneous train-of-four ratio recovery rate was significantly slower in the elderly group (median [25th percentile, 75th percentile]: 1.89 [1.22, 2.90] %/min) than in the nonelderly group (3.45 [1.96, 4.25] %/min, P = 0.024). Train-of-four ratio change rate in response to low-dose sugammadex was significantly slower in elderly (0.55 [-0.29, 1.54] %/min) than in the nonelderly group (1.68 [0.73, 3.13] %/min, P = 0.024). Incidence of recurarization was significantly higher in the elderly group than in the nonelderly group (35% vs. 5%, P = 0.044). Multiple linear regression analyses indicate that slower spontaneous train-of-four ratio recovery rate and impaired renal function are two major contributing factors that decrease train-of-four ratio change rate in response to low-dose sugammadex.ConclusionsElderly patients are at greater risk for recurarization and residual muscle paralysis when low-dose sugammadex is administered.

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