Sugammadex in Emergency Situations

Abstract

Sugammadex may be required or used in multiple emergency situations. Moderate and high doses of this compound can be used inside and outside the operating room setting. In this communication, recent developments in the use of sugammadex for the immediate reversal of rocuronium-induced neuromuscular blockade were assessed. In emergency surgery and other clinical situations necessitating rapid sequence intubation, the tendency to use rocuronium followed by sugammadex instead of succinylcholine has been increasing. In other emergency situations such as anaphylactic shock caused by rocuronium or if intubation or ventilation is not possible, priority should be given to resuming ventilation maintaining hemodynamic stability, in accordance with the traditional guidelines. If necessary for the purpose of resuming ventilation, reversal of neuromuscular blockade should be done in a timely fashion.

Management of Neuromuscular Blocking Agents in Critically Ill Patients with Lung Diseases

“…There is a lack of evidence in the current ICU guidelines [32] relating to monitoring neuromuscular blockade. In the postoperative setting, a residual neuromuscular blockade (TOF < 0.9) is still related to a high incidence of unfavorable outcomes such that quantitative monitoring is considered necessary in the intraoperative management of neuromuscular blockade [75], as recommended by the latest French guidelines [76] on muscle relaxants in 2020 and by new European Society of Anesthesia and Intensive Care and American Society of Anesthesiologists guidelines [75,77]. In accordance with these guidelines, the Italian intersociety consensus on perioperative anesthesia care in thoracic surgery recommends strict neuromuscular monitoring for correct administration of both NMBAs and reversal agents [78].…”