Rapid sequence induction and intubation with rocuronium–sugammadex compared with succinylcholine: a randomized trial

Abstract

RSII with rocuronium followed by reversal with sugammadex allowed earlier re-establishment of spontaneous ventilation than with succinylcholine.

A new option for the treatment of anaphylaxis linked to steroidal neuromuscular blockers: How much value should we grant to case reports?

“…Considering that the sugammadex-rocuronium interaction relies on a 1:1 ratio (one molecule of one compound bound to each molecule of the other compound), 7 it would then be logical to use the same dose suggested for ''rescue reversal'' that has been reported in various studies. [13][14][15][16][17] The goal of those controlled trials was to quickly reverse the NMB action of a very deep block induced with rocuronium, as would be needed with an unexpected cannot ventilate, cannot intubate situation. In the majority of those studies, the main outcome was the time to obtain a train-of-four ratio at the adductor pollicis [ 0.9 following administration of sugammadex, thereby defining complete recovery from the neuromuscular block or at least the absence of residual curarization.…”

“…In the majority of those studies, the main outcome was the time to obtain a train-of-four ratio at the adductor pollicis [ 0.9 following administration of sugammadex, thereby defining complete recovery from the neuromuscular block or at least the absence of residual curarization. The doses of sugammadex (respectively, 8 13 -12 14,15 or 16 [14][15][16][17] mgÁkg -1 ) took into account the dose of rocuronium (respectively, 0.6 13 -1.0 15,17 or 1.2 [14][15][16] mgÁkg -1 ) that had been given to facilitate tracheal intubation and the time interval between the rocuronium and sugammadex injections (respectively, three 13,15,16 five 13,14,17 or fifteen 13,15 min). In each of those cases, the median time to obtain a train of four ratio [ 0.9 at the adductor pollicis was less than five minutes.…”

“…In each of those cases, the median time to obtain a train of four ratio [ 0.9 at the adductor pollicis was less than five minutes. [13][14][15][16][17] For a shorter time (i.e., three minutes after injection of rocuronium), 13,15,16 the dose of sugammadex was between 12 and 16 mgÁkg -1 . [14][15][16][17] Beyond five minutes, a sugammadex dose of 8 13 or 12 14,15 mgÁkg -1 seemed sufficient.…”

“…[13][14][15][16][17] For a shorter time (i.e., three minutes after injection of rocuronium), 13,15,16 the dose of sugammadex was between 12 and 16 mgÁkg -1 . [14][15][16][17] Beyond five minutes, a sugammadex dose of 8 13 or 12 14,15 mgÁkg -1 seemed sufficient. This more or less corresponds to the periods of time reported in clinical cases of rocuronium allergy in which an injection of sugammadex resulted in improved hemodynamic and/or respiratory status within a few minutes (Table).…”

“…Si l'hypothèse de la possibilité de masquer l'antigène responsable de la réaction allergique devait être retenue pour expliquer ces résultats et puisque l'interaction sugammadex-rocuronium se fait sur la base d'un rapport de un pour un (une molécule de l'un se lie à une molécule de l'autre), 7 il serait ainsi logique de retenir les schémas posologiques proposés pour une décurarisation dite de secours, comme cela a pu être testé dans différentes études. [13][14][15][16][17] Dans ces essais contrôlés, l'objectif recherché était de décurariser très précocement un bloc très profond induit par le rocuronium, comme c'est le cas par exemple lors d'une intubation impossible non prévue associée ou non à une impossibilité de ventiler au masque facial. Dans la plupart de ces études, le critère choisi était le délai pour obtenir un rapport de train-de-quatre à l'adducteur du pouce supérieur à 0,9 après l'administration de sugammadex, définissant la récupération complète du bloc neuromusculaire ou pour le moins l'absence de curarisation résiduelle.…”