Low-Dose or High-Dose Rocuronium Reversed with Neostigmine or Sugammadex for Cesarean Delivery Anesthesia: A Randomized Controlled Noninferiority Trial of Time to Tracheal Intubation and Extubation

Štourač, Petr; Adamus, Milan; Seidlová, Dagmar; Pavlík, Tomáš; Janků, Petr; Křikava, Ivo; Mrozek, Z.; Procházka, Martin; Klučka, Jozef; Štoudek, Roman; Bártíková, Ivana; Kosinová, Martina; Harazim, Hana; Robotkova, H.; Hejduk, Karel; Hodická, Zuzana; Kirchnerova, M.; Francakova, J.; Pyszkova, L. Obare; Hlozkova, J.; Ševčík, Pavel

doi:10.1213/ane.0000000000001197

Cited by 35 publications

(10 citation statements)

References 22 publications

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“…Sugammadex was administered for antagonism in 28 studies (supplemental table S13, http://links.lww.com/ ALN/C928). Based on the available information (reported in the publication or obtained from authors), the train-offour ratio was confirmed greater than or equal to 0.9 before extubation in 10 studies, 60,62,68,73,86,118,139,142,179,180 greater than or equal to 0.8 or not stated in 2 studies, 128,191 and unconfirmed in 11 studies 59,63-66, 105,176,184,186,187,189 ; in 6 studies (1 had two strata), whether train-of-four ratio was confirmed could not be determined. 43,61,67,117,182,190 Copyright © 2022, the American Society of Anesthesiologists.…”

Section: Discussionmentioning

confidence: 90%

“…The body of evidence enrolling adults included 191 studies (133 randomized controlled trials, 4,92,95,[98][99][100][101][102][103][104][110][111][112][113][114][118][119][120][121][122][123][124][125][126][127][132][133][134][135][136][137][138][139][140][141][145][146][147][148][155][156][157]163,[173][174][175][176][177][178][179][180][181] 11 nonrandomized trials, …”

Section: Antagonism Of Neuromuscular Blockadementioning

confidence: 99%

“…The body of evidence included 41 studies (26 randomized controlled trials, 41,59–63,65–68,71,73,86,118,139,145,147,173–181 1 before–after design, 44 4 nonrandomized trials, 142,182–184 6 prospective cohort studies, 105,117,185–188 3 retrospective cohort studies, 43,189,190 and 1 fully paired study 58 ) using quantitative monitoring and sugammadex or neostigmine and reporting residual neuromuscular blockade (train-of-four ratio less than 0.9). For studies stratifying randomization, the arms were considered independent.…”

Section: Neuromuscular Monitoring: Confirmation Of Train-of-four Rati...mentioning

confidence: 99%

See 2 more Smart Citations

2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade: A Report by the American Society of Anesthesiologists Task Force on Neuromuscular Blockade

Thilen¹,

Weigel²,

Todd³

et al. 2023

Anesthesiology

113

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Section: Discussionmentioning

confidence: 90%

Section: Antagonism Of Neuromuscular Blockadementioning

confidence: 99%

Section: Neuromuscular Monitoring: Confirmation Of Train-of-four Rati...mentioning

confidence: 99%

See 1 more Smart Citation

2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade: A Report by the American Society of Anesthesiologists Task Force on Neuromuscular Blockade

Thilen¹,

Weigel²,

Todd³

et al. 2023

Anesthesiology

113

View full text Add to dashboard Cite

show abstract

“…Sugammadex, a cyclodextrin, can be used to reverse neuromuscular blockade induced with rocuronium or vecuronium in as little as two minutes 53. However, at this time it has not been studied in parturients though its use has been documented with no ill effect to mother or fetus54 but the ideal dose has yet to be established.…”

Section: Anesthetic Considerations For Cesarean Deliverymentioning

confidence: 99%

<p>Obesity And Obstetric Anesthesia: Current Insights</p>

Taylor¹,

Dominguez²,

Habib³

2019

LRA

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Obesity is a significant global health problem. It results in a higher incidence of complications for pregnant women and their neonates. Cesarean deliveries are more common in obese parturients as well. The increased burden of comorbidities seen in this population, such as obstructive sleep apnea, necessitates antepartum anesthetic consultation. These patients pose unique challenges for the practicing anesthesiologist and may benefit from optimization prior to delivery. Complications from anesthesia and overall morbidity and mortality are higher in this population. Neuraxial anesthesia can be challenging to place in the obese parturient, but is the preferred anesthetic for cesarean delivery to avoid airway manipulation, minimize aspiration risk, prevent fetal exposure to volatile anesthetic, and decrease risk of post-partum hemorrhage from volatile anesthetic exposure. Monitoring and positioning of these patients for surgery may pose specific challenges. Functional labor epidural catheters can be topped up to provide conditions suitable for surgery. In the absence of a working epidural catheter, a combined spinal epidural anesthetic is often the technique of choice due to relative ease of placement versus a single shot spinal technique as well as the ability to extend the anesthetic through the epidural portion. For cesarean delivery with a vertical supraumbilical skin incision, a two-catheter technique may be beneficial. Concern for thromboembolism necessitates early mobilization and a multimodal analgesic regimen can help accomplish this. In addition, thromboprophylaxis is recommended in this population after delivery—especially cesarean delivery. These patients also need close monitoring in the post-partum period when they are at increased risk for several complications.

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“…No difference in the Apgar score between the two groups was noticed. Less resistance during laryngoscopy and a lower incidence of postoperative myalgia were found in the group receiving rocuronium and sugammadex [28]. Since there is only little oral absorption, sugammadex can be administrated safely in breastfeeding women [10].…”

Section: Pregnant and Breastfeeding Womenmentioning

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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Low-Dose or High-Dose Rocuronium Reversed with Neostigmine or Sugammadex for Cesarean Delivery Anesthesia: A Randomized Controlled Noninferiority Trial of Time to Tracheal Intubation and Extubation

Abstract: We conclude that rocuronium for rapid-sequence induction is noninferior for time to tracheal intubation and is accompanied by more frequent absence of laryngoscopy resistance and lower incidence of myalgia in comparison with succinylcholine for cesarean delivery under general anesthesia.

Cited by 35 publications

References 22 publications

2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade: A Report by the American Society of Anesthesiologists Task Force on Neuromuscular Blockade

2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade: A Report by the American Society of Anesthesiologists Task Force on Neuromuscular Blockade

<p>Obesity And Obstetric Anesthesia: Current Insights</p>

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

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