Efficacy, Safety, and Pharmacokinetics of Sugammadex for the Reversal of Rocuronium-induced Neuromuscular Blockade in Elderly Patients

McDonagh, David L.; Benedict, Patrick E.; Kovac, Anthony L.; Drover, David R.; Brister, Neil W.; Morte, Jovino B.; Monk, Terri G.

doi:10.1097/aln.0b013e3182065c36

Cited by 107 publications

(82 citation statements)

References 36 publications

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“…In the present study, in the middle-aged elderly group, the duration of sugammadex effect on recovery period was prolonged by 2.23 min compared to the young elderly group. The study of McDonagh et al (11) was phase 3a. Age related delay in the duration of sugammadex effect is related to many factors.…”

Section: Resultsmentioning

confidence: 99%

A Comparision of the Effect of Sugammadex on the Recovery Period and Postoperative Residual Block in Young Elderly and Middle-Aged Elderly Patients

Yazar¹,

Yılmaz²,

Bilgin³

et al. 2016

Balkan Med J

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Background:The importance of the characteristics of anesthesia and postoperative residual curarization (PORC) in the elderly population should be a growing concern in this century. Aims: To investigate the effect of sugammadex on the duration of the recovery from neuromuscular blocking agents and postoperative residual curarization in the young elderly and middle-aged elderly patients who underwent elective laparoscopic cholecystectomy, followed by a train of four (TOF) watch monitorization. Study Design: Prospective clinical trial study. Methods: Sixty patients over the age of 65 with American Society of Anesthesiologists I-III were divided into two groups according to their age (65-74 years old and ≥75 years old). Patients received sugammadex (2.0 mg/ kg iv) at the reappearance of the second twitch of the TOF as an agent for reversal of neuromuscular blockage at the end of surgery. Patients were extubated at the time of TOF ≥0.9. The patients' TOF responses were evaluated with regards to PORC in at the 5th minute and were followed up for one hour in the recovery room. Reintubation was applied for those patients who developed PORC and had peripheric oxygen saturation <90% despite being given 6 L oxygen per min with a face mask. Results: The onset time of neuromuscular blocking agent and time from T 2 to achieve TOF ratio 90% (the duration of sugammadex effect) or over were found to be longer in the middle-aged elderly group than in the young elderly group. A statistically significant relationship was found between age and the duration of TOF ratio to reach 0.9 in the same direction. The PORC incidence and rate of reintubation were found to be 1.7% in all patients. Conclusion: In our opinion, it is necessary to remember that the duration of sugammadex effect on the recovery period is prolonged for patients who are aged ≥75 years compared to patients aged between 65-74 years. (ClinicalTrials.gov Identifier: ACTRN12615000758505) Keywords: Elderly, postoperative residual curarization, reintubation, sugammadex Young elderly people, middle-aged elderly people, and old elderly people have been classified, respectively, between 65-74 years of age, between 75-84 years of age, and over age 84 by gerontologists (1). A number of studies have indicated that the prevalance of postoperative residual curarization (PORC) increases with age (2,3).The principle of train of four (TOF) Watch was to indicate a pattern of stimulation that did not require the comparison of evoked responses to a control response obtained before administration of a neuromuscular blocking agent (NMBA). As well as enabling the observer to compare T 1 (first twitch of the TOF) to T 0 (control), it also enables comparison of T 4 (fourth

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Section: Resultsmentioning

confidence: 99%

A Comparision of the Effect of Sugammadex on the Recovery Period and Postoperative Residual Block in Young Elderly and Middle-Aged Elderly Patients

Yazar¹,

Yılmaz²,

Bilgin³

et al. 2016

Balkan Med J

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“…Sugammadex is a relatively new and effective agent for reversal of neuromuscular block and has the potential for prevention of residual curarization and respiratory complications owing to its beneficial pharmacological profile [10]consisting of its ability to remove the relaxant molecule from the synaptic gap.…”

Section: Discussionmentioning

confidence: 99%

Residual curarization and postoperative respiratory complications following laparoscopic sleeve gastrectomy. The effect of reversal agents: sugammadex vs. neostigmine

Ezri

Evron

Petrov

et al. 2015

The Journal of Critical Care Medicine

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Background: Incomplete muscle relaxant reversal or re-curarization may be associated with postoperative respiratory complications. In this retrospective study we compared the incidence of postoperative residual curarization and respiratory complications in association with the type of muscle relaxant reversal agent, sugammadex or neostigmine, in patients undergoing laparoscopic sleeve gastrectomy. Material and methods:We reviewed the charts of all patients (179) undergoing laparoscopic sleeve gastrectomy from July 2012 to July 2013 at Wolfson Medical Center. Sugammadex 1.5-2 mg/kg (112 patients) or neostigmine 2.5 mg (67 patients) were used as reversal agents. Results were compared by the type of reversal agent employed. Compared parameters included demographic and anaesthetic data, residual curarization, oxyhemoglobin saturation (SpO 2 ) in the recovery room (PACU), episodes of SpO 2 lower than 90% in PACU, unexpected intensive care (ICU) admissions, incidence of atelectasis and pneumonia, re-intubation and duration of hospitalization. Results: Obstructive sleep apnea syndrome (OSAS) was more frequent in the sugammadex group (19% vs. 8%; p = 0.026). Total intravenous anesthesia (TIVA) was more frequently associated with sugammadex (33% vs. 16%; p = 0.007). There were no differences in postoperative residual curarization, SpO 2 < 90% episodes, reintubation, ICU admissions, pulmonary complications and duration of hospitalization. Conclusion: With the inherent limitations of a retrospective study, the use of sugammadex following laparoscopic sleeve gastrectomy showed no advantage over neostigmine in terms of residual curarization and respiratory complications.

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“…Sugammadeks uygulanan bir hasta 24 saat içinde tekrar operasyona alınacak ve nöromuskuler bloker bir ajan kullanılacaksa, non-steroidal bir ajan (örneğin atrakuryum, mivakuryum gibi) kullanılması önerilmektedir [11]. Yaş artışıyla birlikte sugammadeksle TOF oranının 0,9'a ulaşma süresi de artmasına rağmen ilacın kullanım dozunda yaşa bağlı değişiklik öne-rilmemektedir [12]. Sugammadeksin son zamanlarda kullanıma girdiği bir diğer uygulama da elektrokonvulsif tedavi olmuştur.…”

Section: Discussionunclassified

Comparison of Sugammadex and Neostigmine in Short Term Surgery

Koç¹

2015

Ann Clin Anal Med

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ÖzetAmaç: Bu çalışmada kısa süreli elektif cerrahide; rokuronyumla oluşturulan nöromusküler bloğun geri döndürülmesinde sugammadeks ve neostigminin klinik etki ve maliyeti karşılaştırıldı. Gereç ve Yöntem: Yazılı onayları alındık-tan sonra, ASA I-III, öngörülen cerrahi süresi 90 dakikayı aşmayan, 18-65 yaş arası 33 hasta randomize edilerek iki gruba ayrıldı (Grup Sugammadeks, n=16; Grup Neostigmin, n=17). Anestezi indüksiyonunda tüm hastalara fentanil 1-2 µg/kg, tiopental 5-7 mg/kg, rokuronyum 0,6 mg/kg verildi. İdame-de % 50 O2-N2O ve % 1 sevofluran kullanıldı. Nöromusküler blok seviyesi akselomyolografi metoduyla train-o-four (TOF) stimulasyon ile monitorize edildi. Ameliyat sırasında TOF ölçümleri yapılarak TOF 3 olduğunda 0.1-0.2 mg kg ek rokuronyum yapıldı. Cerrahi sonunda TOF 2 olunca Grup S'ye 2 mg/kg sugammadeks yapılırken Grup N'ye 50 µg/kg neostigmin ve 20 µg/ kg atropin uygulandı. Bulgular: Gruplar arasında demografik özellikler benzerdi. TOF oranı 0,9'a ulaşma ve ekstübasyon süreleri Grup S'de ve Grup N'e göre anlamlı olarak kısaydı (2,3±0,9 dk, 9,4±2,7dk ve 6,6±1,6 dk., 12.9±2 dk) (p<0,001). Hasta başına ortalama maliyet Grup S'de, Grup N'e göre anlamlı olarak fazlaydı. (3,13±0,47 TL, 135,36±17,86 TL) (p<0,001). Tartışma: Rokuronyum sonrası nöromusküler fonksiyonların geri dönmesinde TOF oranı 0.9 olması 2 mg/kg sugammadex ile 50 µg/kg neostigmine göre daha hızlı olmakla birlikte sugammadeks neostigminden çok daha pahalıdır. Anahtar KelimelerSugammadeks; Neostigmin; Nöromusküler Blok Abstract Aim: This study compared the efficacy and cost effectivines of sugammadex and neostigmine for reversal of neuromuscular blockade induced by rocuronium for short term elective surgery. Material and Method: After written informed consent, 33 patients aged 18-65, ASA I-III, who were undergoing short term surgery (<90 min) were randomly selected and divided into two groups (Group Sugamadex, n=16; group Neostigmine, n=17). All patients were given 1,5 µg kg-1 fentanyl, 5-7 mgkg-1 thiopental, 0,6 mg kg-1 rocuronium for anaesthesia induction. Anaesthetic maintenance was ensured through 50% O2-N2O and 1% sevoflurane. Neuromuscular blockade was monitored using acceleromyography and a train-of-four (TOF) mode of stimulation. During surgery maintenance doses of 0.1-0.2 mgkg-1 rocuronium were administered according to reappearance of the third response of the TOF. Patients were given sugammadex 2 mg kg_1(group S) or neostigmine 50 µg kg_1 (with atropine 20 µg kg_1) (group N) at reappearance of the second response of the TOF after the last dose of rocuronium in the end of the surgery. Results: Demographic properties were similar in the two groups. Time to recovery of the TOF ratio of 0.9 and extubation time after sugammadex compared with neostigmine were significantly shorter, being 2.3 ± 0.9 versus 9.4 ± 2.7 min and 6.6 ± 1.6 versus 12.9 ± 2 (P<0.001). The costs were higher in group S (71.2 ± 9.8 $ ) than group N (1.7 ± 0.2 $) per patient (p<0.001). Discussion: Recovery of neuromuscular function after rocuronium to a TOF ...

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Efficacy, Safety, and Pharmacokinetics of Sugammadex for the Reversal of Rocuronium-induced Neuromuscular Blockade in Elderly Patients

Cited by 107 publications

References 36 publications

A Comparision of the Effect of Sugammadex on the Recovery Period and Postoperative Residual Block in Young Elderly and Middle-Aged Elderly Patients

A Comparision of the Effect of Sugammadex on the Recovery Period and Postoperative Residual Block in Young Elderly and Middle-Aged Elderly Patients

Residual curarization and postoperative respiratory complications following laparoscopic sleeve gastrectomy. The effect of reversal agents: sugammadex vs. neostigmine

Comparison of Sugammadex and Neostigmine in Short Term Surgery

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