Sugammadex, a selective reversal medication for preventing postoperative residual neuromuscular blockade

Abrishami, Amir; Ho, Joyce; Yin, Ling; Wong, Jean; Chung, Frances

doi:10.1002/14651858.cd007362

Cited by 10 publications

(9 citation statements)

References 29 publications

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“…Serious complications occurred in less than 1% of the patients who received SUG 4. Reported side effects for SUG included cough, dry mouth, temperature changes, parasomia, paresthesia, movement during surgery, mild erythemia, abdominal discomfort, tachycardia, bradycardia, dizziness, increased creatinine phosphokinase, and increased B2 microglobinuria 3.…”

Section: Introductionmentioning

confidence: 99%

Sugammadex, a Neuromuscular Blockade Reversal Agent, Causes Neuronal Apoptosis in Primary Cultures

Palanca¹,

Aguirre-Rueda²,

Granell³

et al. 2013

Int. J. Med. Sci.

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Sugammadex, a γ-cyclodextrin that encapsulates selectively steroidal neuromuscular blocking agents, such as rocuronium or vecuronium, has changed the face of clinical neuromuscular pharmacology. Sugammadex allows a rapid reversal of muscle paralysis. Sugammadex appears to be safe and well tolerated. Its blood-brain barrier penetration is poor (< 3% in rats), and thus no relevant central nervous toxicity is expected. However the blood brain barrier permeability can be altered under different conditions (i.e. neurodegenerative diseases, trauma, ischemia, infections, or immature nervous system).Using MTT, confocal microscopy, caspase-3 activity, cholesterol quantification and Western-blot we determine toxicity of Sugammadex in neurons in primary culture. Here we show that clinically relevant sugammadex concentrations cause apoptotic/necrosis neuron death in primary cultures. Studies on the underlying mechanism revealed that sugammadex-induced activation of mitochondria-dependent apoptosis associates with depletion of neuronal cholesterol levels. Furthermore SUG increase CytC, AIF, Smac/Diablo and CASP-3 protein expression in cells in culture. Potential association of SUG-induced alteration in cholesterol homeostasis with oxidative stress and apoptosis activation occurs. Furthermore, resistance/sensitivity to oxidative stress differs between neuronal cell types.

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Section: Introductionmentioning

confidence: 99%

Sugammadex, a Neuromuscular Blockade Reversal Agent, Causes Neuronal Apoptosis in Primary Cultures

Palanca¹,

Aguirre-Rueda²,

Granell³

et al. 2013

Int. J. Med. Sci.

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“…[42] In conclusion, sugammadex provides a unique opportunity for cardiac anesthesiologists. Reliable and fast reversal of neuromuscular blockade is available without any important side-effects for this high-risk population of patients.…”

Section: Phase-iii Trialsmentioning

confidence: 97%

Sugammadex - A short review and clinical recommendations for the cardiac anesthesiologist

et al. 2010

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This review outlines the basic pharmacodynamic and pharmacokinetic properties of sugammadex for the cardiac anesthesiologist. It describes the different clinical scenarios when sugammadex can be used during cardiac surgery and gives clinical recommendations. Sugammadex is a unique reversal drug that binds a chemical complex with rocuronium and vecuronium, by which the neuromuscular blockade is quickly reversed. It is free of any clinical side-effects and doses of 2 mg/kg or more reliably reverse neuromuscular blockade within 5-15 min, depending on the depth of the neuromuscular blockade. Doses below 2 mg/kg should be avoided at any time because of the inherent risk of recurarization. Sugammadex should not replace good clinical practice--titration of neuromuscular blocking drugs to clinical needs and objective monitoring of neuromuscular blockade in the operating room or intensive care unit. Neuromuscular transmission should be determined in all patients before sugammadex is considered and 5 min after its administration to ensure that extubation is performed with normal neuromuscular transmission.

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“…34 A apneia prolongada referida por 9% e as arritmias cardía-cas graves por 2% dos respondentes à presente pesquisa está listada nos resultados do estudo de Karanović et al 35 que apresentou os efeitos adversos mais frequentemente relatados para a succinilcolina: mialgia (47%), bloqueio prolongado (36%), reações alérgicas (13%) e assistolia (12%). Revisão sistemática feita por Abrishami et al 36 …”

Section: Complicações Do Uso Do Bloqueadores Neuromusculares E Da Revunclassified

Uso de bloqueadores neuromusculares no Brasil

Locks

Cavalcanti

Duarte

et al. 2015

Brazilian Journal of Anesthesiology

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The objective of this study was to evaluate how Brazilian anesthesiologists are using neuromuscular blockers (NMB), focusing on how they establish the diagnosis of postoperative residual curarization and the incidence of complications associated with the use of NMB. A questionnaire was sent to anesthesiologists inviting them to participate in the study. The online data collection remained open from March 2012 to June 2013. During the study period, 1296 responses were collected. Rocuronium, atracurium, and cisatracurium were the main neuromuscular blockers used in cases of elective surgery. Succinylcholine and rocuronium were the main NMB used in cases of emergency surgery. Less than 15% of anesthesiologists reported the frequent use of neuromuscular function monitors. Only 18% of those involved in the study reported that all workplaces have such a monitor. Most respondents reported using only the clinical criteria to assess whether the patient is recovered from the muscle relaxant. Most respondents also reported always using some form of neuromuscular blockade reversal. The major complications attributed to NMB were residual curarization and prolonged blockade. Eighteen anesthesiologists reported death attributed to NMB. Residual or prolonged blockade is possibly recorded as a result of the high rate of using clinical criteria to diagnose whether the patient has recovered or not from motor block and, as a corollary, the poor use of neuromuscular transmission monitors in daily practice.

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Sugammadex, a selective reversal medication for preventing postoperative residual neuromuscular blockade

Cited by 10 publications

References 29 publications

Sugammadex, a Neuromuscular Blockade Reversal Agent, Causes Neuronal Apoptosis in Primary Cultures

Sugammadex, a Neuromuscular Blockade Reversal Agent, Causes Neuronal Apoptosis in Primary Cultures

Sugammadex - A short review and clinical recommendations for the cardiac anesthesiologist

Uso de bloqueadores neuromusculares no Brasil

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