This is an interesting finding because the lack of a monitoring assay and reversal agent for dabigatran therapy have been important safety concerns for clinicians; cases of bleeding events associated with dabigatran, especially in elderly patients with impaired renal function, have been published in the literature and have received recent regulatory attention in the US and elsewhere [ 24- 28].
Visual stimuli were full-field checkerboard patterns (contrast, 80%; mean luminance, 50 cd/m2) generated on the TV monitor and reversed in contrast at a reversal rate of 3.1 reversals per second.
After which the TOF monitoring was observed, and reversal agents, neostigmine 40 μg/kg with atropine 0.15 mg/kg [ 10], were given only when at least two twitches were present according to TOF monitoring.
Many recent reports indicate that a combination of rocuronium and sugammadex can be safely used for patients with neuromuscular disorders; therefore, we decided to use rocuronium under TOF monitoring and sugammadex for reversal based on these reports [8, 9].
We evaluated two secondary outcomes, which represent strategies used to prevent residual postoperative neuromuscular blockade: monitoring of neuromuscular transmission and reversal of neuromuscular blockade.
To test the secondary research hypotheses that monitoring of neuromuscular transmission and reversal of neuromuscular blockade with neostigmine would influence the outcome criteria, we applied logistic regression analysis in the dataset of the propensity score matched cohort.
In order to compare this method with previously published results, we also exposed animals to a train of mechanostimulatory events by repeatedly exposing their cultivation dish to a non-directional mechanical shock (dropping) and monitoring their reversal magnitude response (Fig. 7A, bottom right).
We also explored whether the monitoring of neuromuscular transmission during surgery and reversal of neuromuscular blockade decrease the risk for postoperative respiratory adverse events.
We also evaluated effects on these outcome variables of qualitative monitoring of neuromuscular transmission (train-of-four ratio) and reversal of neuromuscular blockade with neostigmine to prevent residual postoperative neuromuscular blockade.
Hence, the first step in any AICH is to discontinue the offending drug, administer an antidote (if available) and monitor adequate reversal of anticoagulation.
