Reversal of Rocuronium-induced Neuromuscular Block by the Selective Relaxant Binding Agent Sugammadex

Abstract

At doses of 2.0 mg/kg or greater, sugammadex safely reversed 0.6 mg/kg rocuronium-induced neuromuscular block in a dose-dependent manner. Sugammadex enhanced renal excretion of rocuronium and was excreted unchanged by the kidneys.

Rocuronium‐induced anaphylaxis is probably not mitigated by sugammadex: evidence from an in vitro experiment

“…Jones and Turkstra raised the intriguing question of whether the administration of sugammadex (a selective binding agent that encapsulates rocuronium [1]) mitigates ongoing anaphylaxis due to rocuronium [2]. They speculated that sugammadex might remove free rocuronium molecules from the circulation, and hence slow down or halt the allergic reaction.…”

A reply

“…It is not certain whether the IgE antibodies form a homogeneous group: it is likely that more than one sensitising agent may be involved. The plasma half-life of the sugammadex-rocuronium complex exceeds that of the naked rocuronium molecule [2] and, if the allergenic determinant remains exposed despite the embracing sugammadex molecule, the allergenic determinant may persist in the circulation for longer than would otherwise be the case, with the attendant possibility of exacerbating the anaphylactic reaction.…”

Sugammadex: an opportunity for more thinking or more cookbook medicine?

“…[8][9][10][11] One may criticize the studies because of the choice of accelerometry, which overestimates the degree of recovery, but this drawback is minor considering how effective sugammadex is compared with either placebo or neostigmine. In most clinical circumstances, the time interval from blockade until full recovery is not expected to be particularly critical.…”

“…[8][9][10][11] Dans ces études, on peut critiquer le choix de l'accélérométrie, qui surestime le niveau de récupération, mais ce problème est mineur quand on constate l'efficacité remarquable du sugammadex comparée soit au placebo, soit à la néostigmine. En pratique, l'intervalle entre la curarisation et la récupération complète ne devrait pas être d'une importance cruciale.…”

“…1,10,11 Ces premières recommandations pourraient changer à la lumière de données à venir. On peut expliquer la relation entre la dose de sugammadex et l'intensité de la curarisation par la plus grande quantité de rocuronium à lier dans le plasma quand le bloc neuromusculaire est profond.…”