Sugammadex: the first selective binding reversal agent for neuromuscular block

Kovac, Anthony L.

doi:10.1016/j.jclinane.2009.05.002

Cited by 53 publications

(45 citation statements)

References 64 publications

(154 reference statements)

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“…The underlying mechanism is thought to be related to the redistribution of relaxant after reversal. It may occur when insufficient doses of sugammadex were used which are sufficient for complex formation with relaxant in the central compartment, but insufficient for additional relaxant in peripheral compartments which returned to the central compartment [8][9][10][11].…”

Section: Discussionmentioning

confidence: 99%

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Sugammadex Efficacy for Rapid Reversal of Rocuronium Induced Neuromuscular Blockade in Pediatric Rigid Bronchoscopy Regardless the Depth of Anesthesia

Mogahed¹,

Mohamed²,

Hamed³

2017

J Anesth Clin Res

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Background: Bronchoscopy may be either rigid or flexible. Rigid bronchoscopy is usually done for diagnosis and treatment of intra and/or extra luminal obstruction in the airway for adults and children, anaesthesia for bronchoscopy poses unique challenges for the anaesthesiologist. This procedure needs specific technical precision because both the anaesthesiologist and operator share the same working space, that is, the airway. Pediatric rigid bronchoscopy needs a deep level of general anesthesia with a good (profound) muscle relaxation for a short time, with the modern anesthetic muscle relaxant rocuronium Bromide and its unique rapid onset it gives chance to be used in challenging airway procedures like rigid bronchoscopy and with the its newly advent of selective reversal, sugamadex, encourage its use in pediatric rigid bronchoscopy as it is usually performed for Foreign body removal.

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Section: Discussionmentioning

confidence: 99%

“…Redistribution, metabolism of the neuromuscular blocking agent (NMBA) administered are the main ways to terminate their effect [2]. At the end of bronchoscopy, acetylcholinesterase inhibitors (e.g.…”

Section: Introductionmentioning

confidence: 99%

Sugammadex Efficacy for Rapid Reversal of Rocuronium Induced Neuromuscular Blockade in Pediatric Rigid Bronchoscopy Regardless the Depth of Anesthesia

Mogahed¹,

Mohamed²,

Hamed³

2017

J Anesth Clin Res

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“…This has led to the restricted use of neostigmine [6]. Antagonists of muscle relaxants with novel mechanisms of action have recently been developed for clinical use [4]. Sugammadex is one such antagonist that forms strong bonds to enclose a substance in a process known as clathration.…”

Section: Discussionmentioning

confidence: 99%

“…Given that sugammadex has no parasympathetic stimulatory effects, there is no need to concurrently administer atropine [4].…”

Section: Introductionmentioning

confidence: 99%

Sugammadex is Safe and Effective for Patients with Myasthenia Gravis

Shingu¹,

Nishida²,

Hagiwara³

2011

J Anesthe Clinic Res

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Thymoma, which can be surgically treated under general anesthesia, is associated with the pathophysiology of myasthenia gravis. Muscle weakness is a hallmark of myasthenia gravis; therefore, these patients are hypersensitive to the effects of nondepolarizing muscle relaxants. Neuromuscular blockers can cause prolonged postoperative muscle relaxation, leading to decreased respiratory function. Therefore, careful administration of muscle relaxants during the perioperative period is important. The neuromuscular antagonist, sugammadex, has been used to counteract problems associated with muscle relaxants. By encapsulating nondepolarizing muscle relaxants, sugammadex can reverse the neuromuscular blockade. Here we report three cases of myasthenia gravis. In each case, perioperative management included use of a train-of-four (TOF) monitor to minimize muscle relaxant use during surgery. Sugammadex was administered postoperatively, was safe for use in patients with myasthenia gravis, and may effectively reduce the risk of postoperative respiratory complications.

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“…Reversal agents work either by increasing acetylcholine levels through competitive inhibition of acetylcholinesterase (neostigmine) or by encapsulating aminosteroid NMB agents (sugammadex) [22]. Neostigmine is associated with a higher risk of post operatory residual curaritazion (PORC), compared with sugammadex [23,24].…”

Section: Introductionmentioning

confidence: 99%

Effects of Deep Versus Moderate Neuromuscular Blockade in Laparoscopic Gynecologic Surgery on Postoperative Pain and Surgical Conditions: Protocol for a Randomized Controlled Trial (Preprint)

Robertis¹,

Miceli²,

Colombo³

et al. 2017

Preprint

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Post-operative pain, especially shoulder pain, is commonly reported following laparoscopic gynecologic procedures. Some studies suggest that a lower insufflation pressure may reduce the risk of post-operative pain; however, there is no agreement on the optimal pneumoperitoneum pressure during gynecologic laparoscopic surgery, or whether lower pressure would lead to clinically significant improvements without increasing operative complications. Questions remain regarding the clinical significance of improvements, safety and cost effectiveness of deep neuromuscular blockade with low pressure pneumoperitoneum.The primary objective of this study is to assess the superiority of anesthesia with deep neuromuscular blockade with pneumoperitoneum 8 mmHg over moderate blockade with pneumoperitoneum 12 mmHg, in terms of overall pain 24 hrs after surgery in adult women undergoing pelvic surgery for hysterectomy or benign adnexal diseases. Effects on the intensity and timing of postoperative pain in specific locations, surgeon satisfaction, respiratory and haemodynamic stability, operating times and direct and indirect costs will be assessed.In this multicenter, randomized controlled trial with a superiority design, 300 patients will be randomly allocated 1:1 to moderate neuromuscular blockade with a target insufflation pressure of 12 mmHg or deep neuromuscular blockade with a target insufflation pressure of 8 mmHg, with stratification by type of surgery and clinical center. The patient, the statistician and the nurse who will assess the primary endpoint will be blinded to the allocation.The present study is designed to confirm the reported benefits for postoperative pain and provide additional data needed to address questions regarding the effects of this intervention on operating theatre management, and direct and indirect costs. Strengths of this protocol include the large sample size distributed among diverse institutions across the Italian territory and the collection and analysis of data on numerous secondary objectives. Limitations include the possible introduction of bias because the surgeon and anesthesiologist are not blinded to the intervention.

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Sugammadex: the first selective binding reversal agent for neuromuscular block

Cited by 53 publications

References 64 publications

Sugammadex Efficacy for Rapid Reversal of Rocuronium Induced Neuromuscular Blockade in Pediatric Rigid Bronchoscopy Regardless the Depth of Anesthesia

Sugammadex Efficacy for Rapid Reversal of Rocuronium Induced Neuromuscular Blockade in Pediatric Rigid Bronchoscopy Regardless the Depth of Anesthesia

Sugammadex is Safe and Effective for Patients with Myasthenia Gravis

Effects of Deep Versus Moderate Neuromuscular Blockade in Laparoscopic Gynecologic Surgery on Postoperative Pain and Surgical Conditions: Protocol for a Randomized Controlled Trial (Preprint)

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