Korean J Anesthesiol.  2020 Jun;73(3):239-246. 10.4097/kja.19278.

Effects of different sugammadex doses on the train of four ratio recovery progression during rocuronium induced neuromuscular blockade in the rat phrenic nerve hemidiaphragm

  • 1Department of Anesthesiology and Pain Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
  • 2Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • 3Department of Anaesthesiology and Pain Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
  • 4Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
  • 5Department of Anaesthesiology and Pain Medicine, Daejon Sun Hospital, Daejon, Korea


In this study, we used an ex-vivo model to investigate the recovery pattern of both the train-of-four (TOF) ratio and first twitch tension of TOF (T1), and determined their relationship during recovery from rocuronium-induced neuromuscular blockade at various concentrations of sugammadex.
Tissue specimens of the phrenic nerve-hemidiaphragm were obtained from 60 adult Sprague-Dawley rats. Each specimen was immersed in an organ bath filled with Krebs buffer solution and stimulated with the TOF pattern using indirect supramaximal stimulation at 20-second intervals. After a 30-minute stabilization period, rocuronium loading and booster doses were serially administered at 10-minute intervals in each sample until > 95% depression of T1 was confirmed. Specimens were randomly allocated to either the control group (washout) or to one of five sugammadex concentration groups (0.75, 1, 2, 4, or 8 times equimolar doses of rocuronium to produce >95% T1 depressions; SGX0.75, SGX1, SGX2, SGX4, and SGX8, respectively). Recovery from neuromuscular blockade was monitored using T1 and the TOF ratio simultaneously until the recovery of T1 to > 95% and the TOF ratio to > 0.9.
Statistically significant intergroup differences were observed between the recovery patterns of T1 and the TOF ratio (TOFR, p<0.050), except between SGX2 and SGX4 groups. TOFR/T1 values were maintained at nearly 1 in the control, SGX0.75, and SGX1 groups; however, they were exponentially decayed in the SGX2, SGX4, and SGX8 groups.
Recovery of the TOF ratio may be influenced by the sugammadex dose, and a TOF ratio of 1.0 may be achieved before full T1 recovery if administration of sugammadex exceeds that of rocuronium.


Acetylcholine; Neuromuscular blockade; Neuromuscular blocking agent; Neuromuscular physiology; Rocuronium; Sugammadex

Cited by  1 articles

Adverse events of sugammadex that occurred in a Korean population
Woong Han, Jong Min Lee, Dong Ho Park, Chia An Lee, Chang Yeong Jeong, Hong Seuk Yang
Anesth Pain Med. 2022;17(2):191-198.    doi: 10.17085/apm.21096.

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