Succinylcholine or rocuronium? A meta-analysis of the effects on intubation conditions

Karcıoğlu, Özgür; Arnold, Jeffrey L.; Topaçoğlu, Hakan; Ozucelik, DN; Kıran, Sibel; Sönmez, Nesibe

doi:10.1111/j.1742-1241.2005.00685.x

Cited by 5 publications

(6 citation statements)

References 56 publications

(74 reference statements)

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“…Succinylcholine, a short acting depolarizing NMBA, has a rapid onset and short duration of action [58, 59] and higher doses carry little risk of prolonged paralysis, unless a patient carries a mutation for choline esterase. The use of short acting NMBAs such as succinylcholine and mivacurium may also translate to economical advantages in the context of ambulatory surgery [17, 60].…”

Section: Strategies To Prevent Residual Paralysismentioning

confidence: 99%

Residual Paralysis: Does it Influence Outcome After Ambulatory Surgery?

Farhan

Moreno-Duarte

McLean

et al. 2014

Curr Anesthesiol Rep

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Neuromuscular blocking agents are used to facilitate tracheal intubation in patients undergoing ambulatory surgery. The use of high-dose neuromuscular blocking agents to achieve muscle paralysis throughout the case carries an increased risk of residual post-operative neuromuscular blockade, which is associated with increased respiratory morbidity. Visually monitoring the train-of-four (TOF) fade is not sensitive enough to detect a TOF fade between 0.4 and 0.9. A ratio <0.9 indicates inadequate recovery. Quantitative neuromuscular transmission monitoring (e.g., acceleromyography) should be used to exclude residual neuromuscular blockade at the end of the case. Residual neuromuscular blockade needs to be reversed with neostigmine, but it’s use must be guided by TOF monitoring results since deep block cannot be reversed, and neostigmine administration after complete recovery of the TOF-ratio can induce muscle weakness. The development and use of new selectively binding reversal agents (sugammadex and calabadion) warrants reevaluation of this area of clinical practice.

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Section: Strategies To Prevent Residual Paralysismentioning

confidence: 99%

Residual Paralysis: Does it Influence Outcome After Ambulatory Surgery?

Farhan

Moreno-Duarte

McLean

et al. 2014

Curr Anesthesiol Rep

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“…Firstly, suxamethonium is unique in having a fast onset and short duration of action. Secondly, no other agent is perceived to provide better conditions for tracheal intubation, although rocuronium in large doses (1.2 mg.kg −1 ) is almost as good [51, 52]. Finally, suxamethonium dosing is flexible and there is little penalty in terms of prolonged duration for using increased doses.…”

Section: Will Suxamethonium Still Be Necessary?mentioning

confidence: 99%

Clinical implications of sugammadex

Caldwell¹,

Miller

2009

Anaesthesia

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SummarySugammadex is a cyclodextrin molecule that encapsulates and inactivates rocuronium and vecuronium. As a result, any degree of neuromuscular block produced by rocuronium or vecuronium can be rapidly and completely reversed without autonomic effects. Because sugammadex is optimised for reversing rocuronium it is most likely to be used in conjunction with this drug. Sugammadex will allow deep levels of block to be maintained until the very end of surgery, and will allow block to be reversed at any time after rocuronium administration, even just a few minutes. The recommended dose-range is 2-16 mg.kg-1 (ascender), depending on the level of block. The availability of sugammadex reversal may increase the use of rocuronium, and decrease the use of suxamethonium and benzylisoquinoline neuromuscular blocking drugs. In addition, it will certainly increase pharmacy costs, which may be offset by faster recovery and discharge from the postanesthesia recovery unit. Sugammadex may also change monitoring practices in that post-tetanic count will be required to quantify deep block, and quantitative monitoring of recovery may be driven by cost concerns in order to allow the use of the smallest dose of sugammadex that gives a satisfactory train-of-four ratio. Alternatively, monitoring may essentially be abandoned since a large dose of sugammadex will reliably reverse any degree of rocuronium-induced block. The ultimate clinical utility of sugammadex will be clear only after large-scale clinical use.

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“…Numerosos estudios han abordado la comparación entre SC y Roc 32---36 , e incluso se dispone de revisión Cochrane actualizada 37 y un metaanálisis 38 . La conclusión mayoritaria en todos estos documentos es que las condiciones de intubación son en general mínimamente mejores con SC, aunque en ello influye de manera importante el sedante utilizado (no hay diferencias entre los dos al utilizar propofol, según la revisión Cochrane 37 ), el tipo de paciente y el entorno en el que se realiza 38 .…”

Section: Discussionunclassified

“…La conclusión mayoritaria en todos estos documentos es que las condiciones de intubación son en general mínimamente mejores con SC, aunque en ello influye de manera importante el sedante utilizado (no hay diferencias entre los dos al utilizar propofol, según la revisión Cochrane 37 ), el tipo de paciente y el entorno en el que se realiza 38 . Se incide en la necesidad de considerar las contraindicaciones de SC, lo que matiza las conclusiones de algunos trabajos 39 .…”

Section: Discussionunclassified