{"id":23,"date":"2023-09-04T20:52:44","date_gmt":"2023-09-04T20:52:44","guid":{"rendered":"https:\/\/www.merckconnect.com\/bridion\/?page_id=23"},"modified":"2025-07-29T12:15:16","modified_gmt":"2025-07-29T12:15:16","slug":"nmb-reversal-geriatric-cardiac-pulmonary-patients","status":"publish","type":"page","link":"https:\/\/www.merckconnect.com\/bridion\/nmb-reversal-geriatric-cardiac-pulmonary-patients\/","title":{"rendered":"Reversal of Neuromuscular Blockade (rNMB) in Special Patient Population"},"content":{"rendered":"\n\n

Efficacy for BRIDION\u00ae<\/sup> (sugammadex)<\/strong><\/strong><\/h2><\/div>\n\n\n\n

Recovery in special patient populations<\/strong><\/h1><\/div>\n\n\n\n

Following rocuronium-induced NMB, choose BRIDION\u00ae<\/sup> (sugammadex) to achieve rapid recovery.<\/p>\n\n\n\n\n

<\/div>\n\n\n\n

Clinically relevant recovery is defined as a TOF ratio \u22650.91<\/sup><\/p>\n\n\n\n

<\/div>\n\n\n\n\n
<\/div>
\"Median<\/picture>

<\/p><\/figcaption><\/figure><\/div>\n\n\n\n

\n
\n
<\/div>
\"Median<\/picture>

<\/p><\/figcaption><\/figure><\/div>\n<\/div>\n\n\n\n

\n
<\/div>
\"Median<\/picture>

<\/p><\/figcaption><\/figure><\/div>\n<\/div>\n<\/div>\n\n\n\n

a<\/sup>There were 7 censored observations in the rocuronium group.<\/p>\n\n\n\n

<\/div>\n\n\n\n\n
\"View\"View<\/figure><\/div>\n\n\n\n
<\/div>\n\n\n\n

Moderate block study design2,3<\/sup><\/strong><\/h4><\/div>\n\n\n\n

Multicenter, randomized, parallel-group, active-controlled, safety-assessor-blinded study compared the efficacy of 2 mg\/kg of BRIDION vs 50 \u03bcg\/kg of neostigmine and 10 \u03bcg\/kg of glycopyrrolate for reversal of rocuronium- or vecuronium-induced moderate NMB (reappearance of T2<\/sub>) in 189 patients (87 women and 102 men, ASA majority class 1, 2). Patients underwent elective procedures that were mainly endocrine; ocular; ear, nose, and throat; abdominal (gynecological, colorectal, urological); orthopedic; vascular; or dermatological in nature. An objective monitoring device (TOF-Watch\u00ae SX) was used to evaluate neuromuscular function, to measure the depth of block based on responses to TOF stimulation (TOF count or twitches), and to calculate the degree of recovery using TOF ratio (which cannot be calculated without an objective monitoring device).1,4<\/sup> The primary endpoint was the time from start of BRIDION or neostigmine administration to a TOF ratio of 0.9, which generally correlates with recovery from NMB.<\/p>\n\n\n\n

<\/div>\n\n\n\n

Deep block study design5,6<\/sup><\/strong><\/h4><\/div>\n\n\n\n

Multicenter, randomized, parallel-group, active-controlled, safety-assessor-blinded study compared the efficacy of 4 mg\/kg of BRIDION vs 70 \u03bcg\/kg of neostigmine and 14 \u03bcg\/kg of glycopyrrolate for reversal of rocuronium- or vecuronium-induced deep NMB (1-2 PTCs) in 157 patients (86 women and 71 men, American Society of Anesthesiologists class 1-3). Patients underwent elective surgical procedures that were mainly abdominal (gynecological, colorectal, urological), orthopedic, reconstructive, or neurological in nature. An objective monitoring device (TOF-Watch\u00ae SX) was used to evaluate neuromuscular function, to measure the depth of block based on responses to TOF or PTC stimulation, and to calculate the degree of recovery using TOF ratio (which cannot be calculated without an objective monitoring device).1,7<\/sup> The primary endpoint was the time from start of BRIDION or neostigmine administration to recovery of a TOF ratio of 0.9, which generally correlates with recovery from NMB.<\/p>\n\n\n\n

<\/div>\n\n\n\n\n
\n\n\n\n
<\/div>\n\n\n\n

BRIDION\u00ae<\/sup> (sugammadex) demonstrated efficacy with no dose adjustments in these special patient populations:<\/strong><\/h2><\/div>\n\n\n\n

Geriatric patients<\/a><\/p><\/p>\n\n\n\n

Cardiac patients<\/a><\/p><\/p>\n\n\n\n

Pulmonary patients<\/a><\/p><\/p>\n\n\n\n

Obese patients<\/a><\/p><\/p>\n\n\n\n

<\/div>\n\n\n\n
\n\n\n\n
<\/div>\n\n\n\n

Geriatric patients<\/strong><\/h2><\/div>\n\n\n\n

Recovery in geriatric patients with moderate block<\/strong><\/h3><\/div>\n\n\n\n

In a dedicated clinical study of geriatric patients (n=102) that compared the time to recovery from rocuronium-induced moderate neuromuscular blockade (NMB), BRIDION demonstrated time to recovery of the train-of-four (TOF) ratio to 0.9 comparable with other treatment groups.8<\/sup><\/p>\n\n\n\n

<\/div>\n\n\n\n
<\/div>
\"Median<\/picture>

<\/p><\/figcaption><\/figure><\/div>\n\n\n\n

<\/div>\n\n\n\n
<\/div>
\"Median<\/picture>

<\/p><\/figcaption><\/figure><\/div>\n\n\n\n

<\/div>\n\n\n\n
<\/div>
\"Median<\/picture>

<\/p><\/figcaption><\/figure><\/div>\n\n\n\n

<\/div>\n\n\n\n

Study design8<\/sup><\/strong><\/h4><\/div>\n\n\n\n

Multicenter, parallel-group, open-label study compared the efficacy of 2 mg\/kg of BRIDION for reversal of rocuronium-induced moderate NMB (reappearance of T2<\/sub>) in 48 adult patients (18-64 years)<\/span>, 62 geriatric patients (65-74 years), and 40 older geriatric patients (\u226575 years) (American Society of Anesthesiologists [ASA] class 1-3). The primary endpoint was the time from start of BRIDION administration to a TOF ratio (T4<\/sub>\/ T1<\/sub>) of 0.9.<\/p>\n\n\n\n

<\/div>\n\n\n\n

Recovery in geriatric patients with deep block<\/strong><\/h3><\/div>\n\n\n\n

In an analysis of pooled clinical trial data, BRIDION demonstrated rapid reversal of rocuronium-induced<\/span> deep NMB (TOF count of 0, 1-2 post-tetanic counts<\/span> [PTCs]) to recovery of the TOF ratio to 0.9 in geriatric patients.<\/p>\n\n\n\n

<\/div>\n\n\n\n
<\/div>
\"Median<\/picture>

<\/p><\/figcaption><\/figure><\/div>\n\n\n\n

<\/div>\n\n\n\n
<\/div>
\"Median<\/picture>

<\/p><\/figcaption><\/figure><\/div>\n\n\n\n

<\/div>\n\n\n\n
<\/div>
\"Median<\/picture>

<\/p><\/figcaption><\/figure><\/div>\n\n\n\n\n