Reduced clearance of rocuronium and sugammadex in patients with severe to end-stage renal failure: a pharmacokinetic study †

Staals, Lonneke M.; Snoeck, M.M.J.; Driessen, J. J.; Hamersvelt, Henk W. van; Flockton, E.; Heuvel, Michiel W. van den; Hunter, Jennifer M.

doi:10.1093/bja/aep340

Cited by 133 publications

(131 citation statements)

References 18 publications

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“…12 The distribution of sugammadex is restricted to the intravascular space due to the low volume of distribution at steady state estimated at 0.16 LÁkg -1 . 13 Thus, as is the case for non-depolarizing muscle relaxants, it might be relevant to determine the dose of sugammadex based on the ideal body weight and not on the actual body weight. 14 The affinity of sugammadex for rocuronium is high, so unbinding of sugammadex-rocuronium complexes is unlikely.…”

Section: Discussionmentioning

confidence: 99%

Recurarization after sugammadex reversal in an obese patient

Corre

Nejmeddine

Fatahine

et al. 2011

Can J Anesth/J Can Anesth

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Purpose We report a case that involved immediate postoperative respiratory failure necessitating tracheal intubation, which was possibly related to recurarization after sugammadex reversal. Clinical findings A 54-yr-old woman weighing 115-kg was scheduled for laparoscopic repair of abdominal dehiscence under general anesthesia. Muscle relaxation was induced and maintained with rocuronium (170 mg iv total dose). At the end of the 170-min procedure, two twitches were visualized after supramaximal train-of-four (TOF) stimulation at the adductor pollicis muscle, and the patient's central core temperature was 35.6°C. Sugammadex 200 mg iv (1.74 mgÁkg -1 ) was administered. With the patient fully awake, a TOF ratio 0.9 was obtained five minutes later. The tracheal tube was then removed, and the patient was transferred to the postanesthesia care unit. Ten minutes later, the patient presented respiratory failure necessitating tracheal intubation and sedation with propofol. One TOF response only was visualized at the adductor pollicis muscle. Another dose of sugammadex 200 mg iv was administered. Forty-five minutes later, the patient was fully awake and her trachea was extubated after repeated measures of the TOF ratio (C 0.9) at the adductor pollicis muscle. The patient fully recovered without sequelae, further complication, or prolonged hospital stay. Conclusion Shortly after tracheal extubation, an obese patient experienced respiratory failure necessitating tracheal intubation and an additional dose of sugammadex. This occurred despite initial reversal of neuromuscular blockade with an appropriate dose of sugammadex 2 mgÁkg -1 iv given at two responses to TOF stimulation. RésuméObjectif Nous de´crivons un cas de de´tresse respiratoire survenu en postope´ratoire imme´diat ne´cessitant l'intubation de la trache´e, possiblement lie´a`une recurarisation apre`s une de´curarisation pharmacologique avec du sugammadex. É léments cliniques Une femme de 54 ans, pesant 115 kg, e´tait programme´e pour le traitement chirurgical d'une e´ventration de la paroi abdominale par laparoscopie sous anesthe´sie ge´ne´rale. La curarisation e´tait induite et entretenue par du rocuronium (dose totale 170 mg iv). A`la fin de l'intervention, durant 170 min, deux re´ponses e´taient visualise´es apre`s une stimulation supra-maximale par un train-de-quatre (Td4) a`l'adducteur du pouce, et la tempe´rature centrale e´tait de 35,6°C. Une dose de 200 mg iv de sugammadex (1,74 mgÁkg -1 ) a e´te´administre´e pour la de´curarisation pharmacologique. Un rapport de Td4 a`0,9 al 'adducteur du pouce e´tait obtenu cinq minutes plus tard permettant le retrait de la sonde d'intubation et le transfert en salle de re´veil, la patiente re´pondant aux ordres simples. Dix minutes plus tard, elle pre´sentait une de´tresse respiratoire ne´cessitant l'intubation de la trache´e et une se´dation au propofol. Une seule re´ponse e´tait visualise´e au Td4 a`l'adducteur du pouce. Une dose supple´mentaire de 200 mg iv de sugammadex a e´te´administre´e. Quarante-cinq

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Section: Discussionmentioning

confidence: 99%

Recurarization after sugammadex reversal in an obese patient

Corre

Nejmeddine

Fatahine

et al. 2011

Can J Anesth/J Can Anesth

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“…Therefore, at this time standard dosing continues to be based on weight and train of four twitches as outlined in the Hepatic metabolism is responsible for rocuronium and vecuronium clearance; renal clearance regulates the sugammadex-NMBA complex elimination. 10,[18][19][20][21][22][23][24] In healthy kidneys with a glomerular filtration rate (GFR) of 75-120 ml/min, 70% of the dose is excreted in six hours, and 80-90% in 24 hours. 21,25,26 In renal failure, with GFR <30ml/min, only 29% of the dose administered is cleared by 72 hours.…”

Section: Dosingmentioning

confidence: 99%

“…21,25,26 In renal failure, with GFR <30ml/min, only 29% of the dose administered is cleared by 72 hours. 24 The use of high-flux dialysis removes the bound sugammadex, but at this time sugammadex administration is not recommended for patients with severe renal dysfunction. 16,18,23,24 clinicAl ApplicAtions Sugammadex has many advantages when compared to the administration of neostigmine or no reversal agent at all.…”

Section: Dosingmentioning

confidence: 99%

Sugammadex: A neuromuscular blockade agent encapsulator

Hurtado

2017

The Chronicles

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“…The administration must be modified in patients with renal diseases, adjusting the dosage to the actual renal function. The security in dyalazed patients is limited and the use is not recommended in severe renal failure (creatinine clearance < 30 ml/min) (Abrishami et al, 2010;Della Rocca G et al, 2009;Duvaldestin P et al, 2009;Khuenl-Brady KS et al, 2010;Lee C et al, 2009;McDonagh DL et al, 2011;Plaud B et al, 2009;Schaller SJ et al, 2010;Staals LM et al, 2010;White PF et al,2009) …”

Section: Sugammadexmentioning

confidence: 99%