Introduction
sudden increase
NEUROMUSCULAR BLOCKADE
Sugammadex is a modified γ-cyclodextrin, which promptly reverses the steroidal nondepolarizing neuromuscular blocking agents. Although previous studies have reported a sudden increase in bispectral index (BIS) values after sugammadex reversal of neuromuscular blockade, many studies have supported that BIS increases are likely to be influenced by increased electromyography (EMG) activity following sugammadex administration, rather than true arousalThis study hypothesized that the arousal effect of sugammadex is affected by the underlying degree of sedation. In contrast to prior research that relied on the BIS to assess the arousal effect of sugammadex, which might be disputed because of possible EMG-driven BIS elevation, we focused on the clinical signs of awakening as our primary outcome. We compared the clinical signs of arousal after sugammadex administration between BIS 25 − 35 and 45 − 55 at a steady state using a continuous infusion of propofol and remifentanil.