Saitama Medical University Hospital, Department of anaesthesiolgy Saitama Japan 
Akihiko MAEYAMA, Hiroshi NAGASAKA, Nobuyuki MATSUMOTO

Background and Goal of study
It is well known that renal dysfunction, estimated by plasma creatinine concentrations, increased the risk of residual neuromuscular block(RNMB)induced by rocuronium and that there are possibly no relationships between the dose of sugammadex(SGDX) and recovery from neuromuscular block under renal dysfunctions under various degrees.  However, there are no reports, based on the renal function estimated by Glomerular Filtrating Ratio (eGFR),on the relationship between RNMB, serum albumin, renal dysfunction and during of sevoflurane (SEV) anaesthesia. Therefore, based on the chronic kidney disease (CKD) severity classification by eGFR, we examined the influence of albumin to effect of the SGDX towards the rocuronium in patients under SEV anaesthesia was evaluated by comparing the time required for recovery by determining the time interval between Post tetanic count (PTC) 1 and Train of Four (TOF) ratio 100% using TOF monitoring.
Material and methods: We got the approval of the Ethical Review Board of our hospital and the written consent of patients. Twenty-four adult severe CKD patients of kidney function eGFR<15 who underwent surgery under general anaesthesia at our hospital were included in this study. We divided the patients into two groups: the L group； serum albumin≦3.0g/dl (n=13): and the N group；serum albumin＞3.0g/dl (n=11). Anaesthesia was induced in both groups with 2mg/kg propofol and 0.8mg/kg rocuronium for tracheal intubation and maintained with SEV anaesthesia.
PTC1 state was sustained by administration of an appropriate dosage of rocuronium.
After confirming the PTC1 value at the end of the surgery, pure oxygen was administered, and 4mg/kg SGDX was then intravenously injected over 5second. The time interval between PTC1 and TOF ratio 100% was measured. We used the TOF-watch (T.X.) SX (Organon Ltd., Ireland).The results were expressed as mean±SD.
Data were analyzed with one-way ANOVA. A p value of <0.05 was considered statistically significant. 
Results and discussion: Following SGDX administration, the mean (±SD)time to recovery of PTC1 to TOF ratio 100% was increased to 795±448s in the L group compared with 390±250s in the N group, this difference was statistically significant (p=0.012).
Conclusion(s): In the severe CKD patients, the muscle relaxation recovery time from PTC1 to TOF ratio 100% was prolonged in albuminemia≦3.0g/dl group compared to albumin＞3.0g/dl group during recovery from rocuronium following SEV anaesthesia when using SGDX. We recommend that more careful muscle relaxation monitoring management is necessary for CKD patients with hypoalbuminemia. 

10 / The recovery time of muscle relaxation from rocuronium using sugammadex was significantly prolonged in the most severe CKD group of hypoalbuminemia under sevoflurane anaesthesia