Sugammadex: An Update

Ezri, Tiberiu; Boaz, Mona; Sherman, Alexander E.; Armaly, Marwan; Berlovitz, Yitzhak

doi:10.1515/jccm-2016-0005

Cited by 12 publications

(9 citation statements)

References 31 publications

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“…Sugammadex, a selective relaxant‐binding agent, was specifically developed for rapid reversal of rocuronium‐induced NMB 22 . By selectively binding to NMB agents, sugammadex inactivates free NMB agents in the plasma, resulting in a large concentration gradient of NMB agent molecules between the neuromuscular junction and the plasma, leading to decreased NMB agents at the neuromuscular junction end plate 23 . This mechanism allows neuromuscular transmission to resume in a short period of time, making it a more popular drug for IONM compared with other reversal agents 24 .…”

Section: Discussionmentioning

confidence: 99%

“…While NMB reversal is crucial for IONM, maintaining adequate muscle relaxation during surgery is even more important. Because sugammadex allows faster return of muscle activity, bucking and movement during surgery are the most frequently reported adverse effects associated its use 23 . In fact, studies have reported that 20–35% of patients administered sugammadex (2 mg/kg) as a reversal agent for IONM had bucking events during surgery 7,21 .…”

Section: Discussionmentioning

confidence: 99%

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Investigation of potential neuropharmacological activity of neostigmine‐glycopyrrolate for intraoperative neural monitoring in thyroid surgery

Lee

Won

et al. 2021

The Kaohsiung J of Med Scie

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Intraoperative neuromonitoring (IONM) is frequently used in thyroid surgery to reduce recurrent laryngeal nerve injury. The use of neuromuscular blockade agent to facilitate tracheal intubation, is a common cause of IONM failure. We performed a retrospective analysis to assess the efficacy of neostigmine‐glycopyrrolate as a neuromuscular blockade reversal agent for IONM during thyroid surgery. Rocuronium (0.6 mg/kg) was administered for muscle relaxation. Neostigmine (2 mg) and glycopyrrolate (0.4 mg) were administered immediately after intubation. Cricothyroid muscle‐twitch response upon external branch of superior laryngeal nerve stimulation and electromyography amplitudes of vagal and recurrent laryngeal nerves before (V1, R1) and after thyroid resection (V2, R2) were recorded. Fifty patients (23 males, 27 females) were included in the analysis. The diagnoses comprised 43 papillary thyroid carcinomas and seven benign diseases. The mean time between rocuronium injection and neostigmine‐glycopyrrolate injection was 5.1 ± 1.2 min, and the mean time from neostigmine‐glycopyrrolate injection to successful cricothyroid muscle twitching upon external branch of superior laryngeal nerve stimulation was 21.0 ± 4.5 min. All patients had V1 and R1 amplitudes of more than 500 μV each, with mean V1 and R1 amplitudes of 985.3 ± 471.6 μV and 1177.2 ± 572.7 μV, respectively. Neostigmine‐glycopyrrolate was effectively used as a neuromuscular blockade reversal agent for IONM in thyroid surgeries without a significant increase in bucking events. Administration of neostigmine‐glycopyrrolate immediately after intubation can be recommended for successful NMB reversal to facilitate IONM during thyroid surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Investigation of potential neuropharmacological activity of neostigmine‐glycopyrrolate for intraoperative neural monitoring in thyroid surgery

Lee

Won

et al. 2021

The Kaohsiung J of Med Scie

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“…However, it should be noted that the CICO scenario is often multifactorial and reversing NMB agents may not always be a solution. 10 In these cases, emergent tracheostomy may be required, and, therefore, the operating room would be an ideal environment. In our hospital, an otolaryngologist is not always present in cases when difficult intubation is anticipated.…”

Section: Discussionmentioning

confidence: 99%

Airway Management and Risk Factors for Prolonged Intubation in Patients with Severe Croup

Tsuboi

et al. 2021

J Pediatr Intensive Care

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Croup is a common respiratory illness in children with a substantial variation in the severity of symptoms. Most of the patients present with mild symptoms, but patients with severe croup require intensive care unit (ICU) management. The aim of this study was to investigate the airway management of patients with severe croup who required intubation and determine the risk factors for prolonged intubation. We performed an 18-year retrospective observational cohort study at the pediatric ICU of a tertiary children's hospital in Japan. A total of 16 patients with croup who were intubated for upper airway obstruction were included in the study. Most patients (13of 16, 81%) were intubated with an endotracheal tube (ETT) smaller than their age-appropriate size. The median difference in the internal diameter (ID) between the selected ETT and the age-appropriate size was 1.0 mm (interquartile range: 0.5–1.0). Multivariate analysis performed on factors affecting the cumulative incidence of extubation revealed that the difference in ID between the selected ETT and age-appropriate size (mm) significantly reduced the duration of intubation (hazard ratio: 0.092, p = 0.03). A downsized ETT without a cuff may be recommended for intubation of patients with croup.

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“…Our survey asked participants whether or not their hospitals had access to sugammadex and whether or not they had policies for the use of sugammadex. Based on current literature, we identified eight clinical scenarios in which sugammadex may be indicated for use . Similarly, we identified four patient populations where sugammadex may be specifically indicated.…”

Section: Methodsmentioning

confidence: 99%

Sugammadex in Ontario hospitals: Access and institutional policies

Cohen

Latchford

2019

Evaluation Clinical Practice

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Rationale and aims:Sugammadex is a novel neuromuscular blockade reversal agent which rapidly reverses the effects of rocuronium and vecuronium. Compared with the first-generation neuromuscular blockade reversal agent, neostigmine, sugammadex has a number of superior properties; however, sugammadex is significantly more expensive per dose compared with neostigmine (~CAD$95 vs $4). Given the high cost of sugammadex, many Ontario hospitals either do not stock the drug or have specific policies on when the drug can be administered. This study was designed to determine access to sugammadex in Ontario hospitals, as well as the prevalence and content of institutional policies on its use. Methods:We designed a survey assessing the availability of sugammadex and institutional policies on its use. We identified 60 Ontario hospitals with surgical services and obtained contact information for 45 of the anaesthesia departments. Surveys were sent to each department chief, and results were collected from July to October 2018.Results: Thirty-four (75.6%) hospitals responded to the survey. Twenty-seven (79.4%) of the 34 respondent hospitals had sugammadex. Of the seven hospitals that did not have sugammadex, six were group B hospitals, and one was a paediatric hospital. Of the 27 hospitals with sugammadex, 16 (59.3%) hospitals had specific policies on when sugammadex may be used. Based on policies, sugammadex was most frequently allowed to be used in emergency situations, especially failed intubations or "can't intubate, can't ventilate" situations where 100% of policies allowed its use. Policies on specific patient populations for sugammadex use were uncommon, with 43.8% of existing hospital policies not specifying any patient populations. Conclusions:Though most hospitals have sugammadex available, there is a marked heterogeneity in hospital policies on its use. Given the high cost of sugammadex use, it is worthwhile to have evidence-based policies on its use. Judicious use of sugammadex may also have secondary cost-saving benefits, through improved operating room efficiency and decreased complication rates.

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Sugammadex: An Update

Abstract: The purpose of this update is to provide recent knowledge and debates regarding the use of sugammadex in the fields of anesthesia and critical care. The review is not intended to provide a comprehensive description of sugammadex and its clinical use.

Cited by 12 publications

References 31 publications

Investigation of potential neuropharmacological activity of neostigmine‐glycopyrrolate for intraoperative neural monitoring in thyroid surgery

Investigation of potential neuropharmacological activity of neostigmine‐glycopyrrolate for intraoperative neural monitoring in thyroid surgery

Airway Management and Risk Factors for Prolonged Intubation in Patients with Severe Croup

Sugammadex in Ontario hospitals: Access and institutional policies

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