Pharmacokinetics of sugammadex in subjects with moderate and severe renal impairment

Min, kweonsik; Lasseter, Kenneth C.; Marbury, Thomas; Wrishko, Rebecca E.; Hanley, William D.; Wolford, Dennis; Haes, Joanna Udo de; Reitmann, Christina; Gutstein, David E.

doi:10.5414/cp203025

Cited by 15 publications

(23 citation statements)

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“…Moreover, no clinical data on long-term disposition of the sugammadex–rocuronium complex, which is retained in the body of a patient with renal failure, are available. Thus, although the sugammadex-rocuronium complex is dialysable through high-flux dialysis [ 43 ], the use of sugammadex in patients with severe renal failure should be carefully considered, with appropriate postoperative neuromuscular monitoring [ 44 , 45 ]. Recently, in an elderly patient with end-stage renal failure, erratic infiltration of subcutaneous rocuronium was successfully managed with sugammadex and the duration of action was sufficient to neutralize the ongoing absorption of subcutaneous rocuronium [ 46 ].…”

Section: Use Of Sugammadex In a Special Clinical Situationmentioning

confidence: 99%

Advantages and pitfalls of clinical application of sugammadex

Lee

Jung

2020

Anesth Pain Med

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Sugammadex, a modified γ-cyclodextrin, is one of the drugs focused on in the anesthetic field because it provides rapid and complete reversal from neuromuscular blockade (NMB) by encapsulating rocuronium. Its introduction has revolutionized anesthesia practice because it is a safe, predictable, and reliable neuromuscular antagonist. Hence, its use has increased worldwide. Further, it has been in the spotlight for recovering from deep NMB in laparoscopic surgery and improving the surgical condition. Recently, studies have been conducted on the postoperative outcome after deep NMB and use of sugammadex in various clinical conditions. However, with increase in sugammadex use, reports regarding its complications are increasing. Appropriate dosing of sugammadex with quantitative neuromuscular monitoring is emphasized because under-dosing or over-dosing of sugammadex might be associated with unexperienced complications. Sugammadex is now leaping into an ideal reversal agent, changing the anesthesia practice.

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Section: Use Of Sugammadex In a Special Clinical Situationmentioning

confidence: 99%

Advantages and pitfalls of clinical application of sugammadex

Lee

Jung

2020

Anesth Pain Med

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“…[ 1 ] The preceding dose of sugammadex should have therefore minimally impacted exposure to sugammadex, as the period between the doses exceeded that of four half-lives. Sugammadex is renally cleared; moderate renal impairment can increase exposure by a factor of 2.42 [ 1 , 6 ]. Our patient's estimated creatinine clearance decreased to 45.12 mL/min after the third operation, corresponding with moderate renal impairment in the study by Min et al [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Suspected Sugammadex Hypersensitivity following Repeated Administration in the Setting of Multiple Flap Takebacks in a Brief Timespan

Zolper

Kim

et al. 2021

Case Reports in Anesthesiology

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Sugammadex hypersensitivity is an uncommon event that typically occurs at higher doses. We report a case of suspected sugammadex hypersensitivity in a patient who developed hypoxia and bronchospasm following three administrations of the standard 2 mg/kg doses of sugammadex within 26 hours due to flap takebacks. Hypersensitivity to sugammadex was not initially suspected given that the patient had previous exposures. Diagnoses of pneumothorax, hemothorax, mucus plug, and tracheal tube malposition were immediately ruled out. Furthermore, the onset of hypoxia with sudden loss of tidal volume, development of high peak airway pressures, and temporal correlation with sugammadex administration all supported bronchospasm secondary to a hypersensitivity reaction. Sugammadex is a useful agent for neuromuscular blockade reversal; however, it is critical to carefully examine all adverse reactions. This case report highlights the importance of considering hypersensitivity reactions in the setting of repeat sugammadex administrations in a limited timeframe, such as in free flap reconstruction requiring multiple takebacks to the operating room in the setting of flap compromise.

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“…Ninety-six percent of sugammadex molecules are excreted in urine and clearance of sugammadex and sugammadex-rocuronium complex significantly decreases in patients with moderate to severe renal dysfunction. 34 However, sugammadex 4 mg/kg effectively reverses rocuronium-induced deep paralysis without dose adjustment although time to complete recovery is prolonged, 35,36 and larger dose of rocuronium is necessary to paralyze patients with renal dysfunction after reversal with sugammadex. In contrast, we found the reduced estimated glomerular filtration rate to be an independent risk factor for the reduced train-of-four ratio recovery rate and recurarization when low-dose sugammadex was administered.…”

Section: Clinical Implications Of the Study: Elderly Patients As A Himentioning

confidence: 99%

Differences of Recovery from Rocuronium-induced Deep Paralysis in Response to Small Doses of Sugammadex between Elderly and Nonelderly Patients

et al. 2018

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Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Complete recovery from rocuronium-induced muscle paralysis with sugammadex is reported to be delayed in elderly patients. The authors tested a hypothesis that recovery from deep neuromuscular block with low-dose sugammadex is slower (primary hypothesis) and incidence of recurarization is higher (secondary hypothesis) in elderly patients than in nonelderly patients. Methods In anesthetized elderly (n = 20; 76.9 ± 5.0 yr of age) and nonelderly patients (n = 20; 53.7 ± 12.8 yr of age) under deep paralysis with rocuronium, change of train-of-four ratio per minute (primary outcome variable) was measured with an acceleromyograph neuromuscular monitor during spontaneous recovery from rocuronium-induced muscle paralysis (0.6 mg/kg) and after infusion of low-dose sugammadex (50 µg · kg-1 · min-1). Recurarization was defined as the negative change of train-of-four ratio. Results Spontaneous train-of-four ratio recovery rate was significantly slower in the elderly group (median [25th percentile, 75th percentile]: 1.89 [1.22, 2.90] %/min) than in the nonelderly group (3.45 [1.96, 4.25] %/min, P = 0.024). Train-of-four ratio change rate in response to low-dose sugammadex was significantly slower in elderly (0.55 [–0.29, 1.54] %/min) than in the nonelderly group (1.68 [0.73, 3.13] %/min, P = 0.024). Incidence of recurarization was significantly higher in the elderly group than in the nonelderly group (35% vs. 5%, P = 0.044). Multiple linear regression analyses indicate that slower spontaneous train-of-four ratio recovery rate and impaired renal function are two major contributing factors that decrease train-of-four ratio change rate in response to low-dose sugammadex. Conclusions Elderly patients are at greater risk for recurarization and residual muscle paralysis when low-dose sugammadex is administered.

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Pharmacokinetics of sugammadex in subjects with moderate and severe renal impairment

Cited by 15 publications

References 0 publications

Advantages and pitfalls of clinical application of sugammadex

Advantages and pitfalls of clinical application of sugammadex

Suspected Sugammadex Hypersensitivity following Repeated Administration in the Setting of Multiple Flap Takebacks in a Brief Timespan

Differences of Recovery from Rocuronium-induced Deep Paralysis in Response to Small Doses of Sugammadex between Elderly and Nonelderly Patients

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