Sugammadex in anticipated difficult airways³

Sugammadex: What do we Know and What do we Still Need to Know? A Review of the Recent (2013 to 2014) Literature

“…Many papers discuss the use of sugammadex in difficult airway/'can't intubate, can't ventilate' scenarios [26][27][28][29][30][31][32][33][34][35][36][37] . A further article investigated the effect of sugammadex on verapamil toxicity 38 .…”

“…There is no doubt that sugammadex is one strategy to rescue the lost airway in some cases, and the drug should ideally be kept on difficult airway trolleys. However, many letters to the editor [26][27][28][29] in reply to the case report by Paton et al 34 , as well as an editorial by Mendonca 32 accompanying the publication of the same case report in Anaesthesia, have again made it clear that sugammadex should not be seen as the 'silver bullet' of difficult airway treatment and that it should not become an integral part of the difficult airway algorithm. Prior to reversal of muscle relaxation with sugammadex in a 'can't intubate, can't ventilate' scenario, it must specifically be clear whether a 'way back' realistically exists.…”

Anaesthetic management of acute airway obstruction

“…(68,69) Sugammadex has been used to 'rescue' intense neuromuscular block after induction of patients with AAO; (70,71) however, these cases were criticised for an overreliance on the drug's ability to guarantee rapid reversal, and a lack of logical induction, intubation and exit strategies. (72)(73)(74)(75)(76)(77)(78)(79) Other considerations include the cost and the time to find and draw-up sugammadex, (80) and the potential of developing negative pressure pulmonary oedema if the AAO remains unresolved but breathing resumes, generating a large, negative intrathoracic pressure. (c) NAP4 recommends the use of muscle relaxants in CICV cases as they may resolve failure to ventilate caused by laryngospasm and aid mask ventilation.…”