Efficacy and safety of sugammadex in the reversal of deep neuromuscular blockade induced by rocuronium in patients with end-stage renal disease

Souza, Camila Machado de; Tardelli, Maria Ângela; Tedesco, H.; García, Natalia Navarro; Caparrós, M. Parreño; Álvarez‐Gómez, José A.; Oliveira, Itamar S de

doi:10.1097/eja.0000000000000312

Cited by 52 publications

(48 citation statements)

References 22 publications

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“…During the 34-month study period, 125,653 cases of general anaesthesia were performed (55,859 at UPMC and 69,794 at MSKCC). Overall, sugammadex was used in 26,650 (21%) cases (12,161 The fate of the sugammadex-rocuronium complex and sugammadex is uncertain in patients with end-stage renal disease since the complex is renally excreted and not removed with a standard form of dialysis [7]. There is concern for potential recurrence of postoperative neuromuscular blockade in patients with end-stage renal disease if the sugammadex-rocuronium complex disassociates and a free form of rocuronium is released to cause muscle weakness or paralysis.…”

Section: Resultsmentioning

confidence: 99%

Short‐term safety and effectiveness of sugammadex for surgical patients with end‐stage renal disease: a two‐centre retrospective study

et al. 2019

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Summary Sugammadex is a novel reversal agent for aminosteroid neuromuscular blocking drugs, especially rocuronium. Given its renal excretion, sugammadex is not recommended for patients with end‐stage renal disease; however, reports exist of its use in this group of patients. This two‐institutional retrospective observational study aimed to review the safety profile and effectiveness of sugammadex in surgical patients with end‐stage renal disease who required pre‐operative renal replacement therapy. Adult surgical patients with end‐stage renal disease requiring pre‐operative renal replacement therapy, who received sugammadex between April 2016 and January 2019, were studied. The primary outcome was the incidence of postoperative tracheal re‐intubation within 48 h. The secondary outcome was the incidence of deferred tracheal extubation in the operating theatre. One hundred and fifty‐eight patients were identified from 125,653 surgical patients: 48 patients (30%) underwent renal transplantation and 110 (70%) underwent non‐renal transplantation procedures. There were 22 instances (14%) of deferred tracheal extubation due to surgical and/or pre‐existing medical conditions. Out of the 136 patients who had the tracheal tube removed at the end of the procedure, three patients had their trachea re‐intubated within 48 h: two patients developed pulmonary oedema resulting from volume overload; and one patient had worsening sepsis. No incidence of recurrence of neuromuscular blockade was observed. Of note, 24 (18%) patients were found to have incomplete neuromuscular blockade reversal with neostigmine but administration of sugammadex led to successful tracheal extubation. In conclusion, sugammadex appears to be safe and effective in adult patients with end‐stage renal disease receiving pre‐operative renal replacement therapy.

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Section: Resultsmentioning

confidence: 99%

Short‐term safety and effectiveness of sugammadex for surgical patients with end‐stage renal disease: a two‐centre retrospective study

et al. 2019

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“…SUG is eliminated unaltered via urine 23,24 and the inactive complex ROC-SUG or VEC-SUG is rapidly cleared through the kidney, according to the pharmacokinetic properties of SUG 25,26,5. Therefore, when renal or hepatic function is impaired, ROC, VEC and SUG half-life and plasma concentration can be increased 22.…”

Section: Discussionmentioning

confidence: 99%

Neuronal Effects of Sugammadex in combination with Rocuronium or Vecuronium

Aldasoro¹,

Vallés²,

Aldasoro

et al. 2017

Int. J. Med. Sci.

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Rocuronium (ROC) and Vecuronium (VEC) are the most currently used steroidal non-depolarizing neuromuscular blocking (MNB) agents. Sugammadex (SUG) rapidly reverses steroidal NMB agents after anaesthesia. The present study was conducted in order to evaluate neuronal effects of SUG alone and in combination with both ROC and VEC. Using MTT, CASP-3 activity and Western-blot we determined the toxicity of SUG, ROC or VEC in neurons in primary culture. SUG induces apoptosis/necrosis in neurons in primary culture and increases cytochrome C (CytC), apoptosis-inducing factor (AIF), Smac/Diablo and Caspase 3 (CASP-3) protein expression. Our results also demonstrated that both ROC and VEC prevent these SUG effects. The protective role of both ROC and VEC could be explained by the fact that SUG encapsulates NMB drugs. In BBB impaired conditions it would be desirable to control SUG doses to prevent the excess of free SUG in plasma that may induce neuronal damage. A balance between SUG, ROC or VEC would be necessary to prevent the risk of cell damage.

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“…Nevertheless, clinicians should bear in mind that a substantial variability in the times to reach a TOF ratio of 0.9 in these patients with chronic renal failure might be observed [56]. Such variability could be explained by the kidney donor status [57]. When the transplanted kidney comes from a recently deceased donor the renal function does not recover instantly [57].…”

Section: Patients With Renal Failurementioning

confidence: 99%

“…Such variability could be explained by the kidney donor status [57]. When the transplanted kidney comes from a recently deceased donor the renal function does not recover instantly [57]. However, considering the limited number of trials and patients with severe renal impairment exposed to prolonged sugammadex-rocuronium complex, caution should be maintained in this population.…”

Section: Patients With Renal Failurementioning

confidence: 99%

A Short Update on Sugammadex with a Special Focus on Economic Assessment of its Use in North America

Zaouter¹,

Mion²,

Palomba³

et al. 2017

J Anesth Clin Res

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Sugammadex offers significant advantages over the current anticholinesterase reversal drugs. Sugammadex used has been approved for the United Stated and for Canada since December 2015 and February 2016, respectively. The present article aims to provide a straightforward and concise review of the most recent literature describing its clinical advantages in routine use. A thorough and cost-effective evaluation has been conducted specifically for North America to determine if its price justifies its inclusion into regular patients' care. The search examined the relevant literature from January 2013 to October 2016. The present narrative review describes how sugammadex could play a crucial role in the modern conduct of anesthesia. The particular emphasis on sugammadex cost-effective analysis performed in this article suggests that this new reversal agent should be considered for a wider use in North America.

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Efficacy and safety of sugammadex in the reversal of deep neuromuscular blockade induced by rocuronium in patients with end-stage renal disease

Abstract: Clinicaltrials.gov identifier NCT01785758.

Cited by 52 publications

References 22 publications

Short‐term safety and effectiveness of sugammadex for surgical patients with end‐stage renal disease: a two‐centre retrospective study

Short‐term safety and effectiveness of sugammadex for surgical patients with end‐stage renal disease: a two‐centre retrospective study

Neuronal Effects of Sugammadex in combination with Rocuronium or Vecuronium

A Short Update on Sugammadex with a Special Focus on Economic Assessment of its Use in North America

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