TOPLINE

Among emergency department (ED) patients with traumatic brain injury (TBI) or spontaneous intracranial hemorrhage (sICH), 54% had an increase in Glasgow Coma Scale (GCS) scores after sugammadex reversed rocuronium-induced paralysis; those with a positive neurologic response were more likely to receive new analgesic or sedative agents within 30 minutes.

METHODOLOGY

• Researchers conducted a multicenter, retrospective observational cohort study across 11 US EDs, including adults with TBI or sICH who received rocuronium followed by sugammadex between 2015 and 2024.
• A total of 362 patients with GCS measurements at baseline and after sugammadex administration were included in the primary outcome analysis.
• The primary outcome was a positive response, defined as an increase of at least 1 point on the GCS within 30 minutes of sugammadex administration. Secondary outcomes included changes in blood pressure and heart rate, analgesic and sedative requirements, neurosurgical procedures within 24 hours, and adverse events.
• Patients were categorized as responders (an increase in the GCS score of ≥ 1 point) or nonresponders (no change or a decrease in the GCS score) after sugammadex administration.

TAKEAWAY

• Overall, 54% of patients had a positive response within 30 minutes of sugammadex administration, with a median change in the GCS score of 3 points from baseline.
• Heart rate and blood pressure decreased in both groups after sugammadex administration. Within 30 minutes, bradycardia occurred in 3.1% of responders and 7.8% of nonresponders, whereas hypotension occurred in 4.1% of responders and 6.0% of nonresponders.
• Patients with a positive GCS response were more likely than nonresponders to receive a new analgesic agent (30.6% vs 13.9%) or sedative agent (33.7% vs 14.5%) within 30 minutes after sugammadex. Neurosurgical procedures were required by 43.4% of responders vs 33.7% of nonresponders; however, the difference was not statistically significant.
• Patients with a positive GCS response had lower in-hospital mortality than nonresponders (51.0% vs 78.9%). After adjustment for age, the type of ICH, the mechanism of injury, the baseline GCS score, and the rate of neurosurgical procedures, the odds of in-hospital death remained lower among responders (adjusted odds ratio, 0.13; 95% CI, 0.07-0.25).

IN PRACTICE

"Our study found that sugammadex administration was associated with positive GCS change in over half of patients. A positive GCS response was associated with a higher rate of neurosurgical procedures, increased analgosedation requirements, and improved survival to discharge," the authors wrote.

SOURCE

The study was led by Christine Lawson, Brown University Health, Providence, Rhode Island. It was published online on June 21, 2026, in The American Journal of Emergency Medicine.

LIMITATIONS

The study was limited by its retrospective design, incomplete clinical data, and unmeasured confounding. The primary outcome was defined as an increase of at least 1 point in the GCS score, which may not have represented a clinically meaningful neurologic improvement. The study lacked a comparator group. Limited documentation of train-of-four monitoring prevented confirmation of the depth of paralysis and response to sugammadex. Lastly, the findings were not generalizable to nonacademic centers.

DISCLOSURES

The study was partly funded by the Investigator-Initiated Studies Program of Merck Sharp & Dohme LLC. Additional funding was provided by the National Center for Advancing Translational Sciences of the National Institutes of Health for the REDCap database and the US Department of Veterans Affairs Health Systems. One author reported receiving funding from Merck & Co Inc. Full disclosures are provided in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.