Dialysability of sugammadex and its complex with rocuronium in intensive care patients with severe renal impairment

Renal excretion is the primary route for the elimination of sugammadex. We evaluated the dialysability of sugammadex and the sugammadexrocuronium complex in patients with severe renal impairment in the intensive care unit (ICU). Six patients in the ICU with acute severe renal impairment received general anaesthesia for transoesophageal echocardiography, to replace their tracheal tubes, or for bronchoscopy. Five of the six patients were in the ICU after cardiac/vascular surgery and one for pneumonia-induced respiratory failure. They all received rocuronium 0.6 mg kg(1), followed 15 min later by sugammadex 4.0 mg kg(1). Two patients were studied for two dialysis episodes and four patients for four episodes. Rocuronium and sugammadex concentrations were measured in plasma and dialysate at several time points before, during, and after high-flux dialysis. Dialysis clearance in plasma and dialysate, and reduction ratio (RR) (the extent of the plasma concentration reduction at the end of a dialysis episode when compared with before dialysis) were calculated for each dialysis episode. Dialysis episodes lasted on average 6 h. Observed RRs indicated mean reductions of 69 and 75 in the plasma concentrations of sugammadex and rocuronium, respectively, during the first dialysis episode. Reductions were around 50 during sequential dialysis episodes. On average, dialysis clearance of sugammadex and rocuronium in blood was 78 and 89 ml min(1), respectively. Haemodialysis using a high-flux dialysis method is effective in removing sugammadex and the sugammadexrocuronium complex in patients with severe renal impairment.