Unexpected failure of rocuronium‐mediated neuromuscular blockade

Safety and Efficacy of Sugammadex for Neuromuscular Blockade Reversal

“…30 Sugammadex is not currently recommended for use in patients with severe renal impairment (creatinine clearance <30 mL/minute) as elimination can be significantly delayed and result in a prolonged duration of action (.24 hours), which may be problematic if further doses of aminosteroid are to be given. 22,48,49 There is also data suggesting that neuromuscular block reversal is slower with sugammadex in severe renal impairment, although no firm conclusions have yet been made and warrant further investigation. 50,51 Despite this, sugammadex use in end-stage renal failure appears to be safe and effective at reversing rocuronium blockade, with a number of cases reporting successful clinical use without adverse effects (AE).…”

Needlestick injuries: strategies for patient testing are feasible

“…Administration of atracurium, even when using the priming principle, has prolonged mean onset times, making this drug less ideal in avoiding aspiration of stomach contents in emergency surgical operations [1]. We therefore preferred rocuronium due…”

“…The intensive care survey [1] and accompanying editorial [2] on serological testing of the patient lacking capacity following needlestick injury collectively set out the diversity of clinical approach, the ethical and legal dimensions and the initiatives of the Association of Anaesthetists of Great Britain & Ireland (AAGBI). The subsequent correspondence unequivocally sets out the impact on front-line staff of the impasse and the frustration at the apparent inertia of those bodies with the authority to resolve this vexed issue [3][4][5][6].…”

“…If the Department of Health can provide clarification on what is permissible to benefit a third party on adults lacking capacity, and expects the support of the critical care community for this field of organ donation, it should also extend the same principles to this particular problem. Unexpected failure of rocuronium-mediated neuromuscular blockade I read with interest the experiences of Dr Deckert et al who described resistance of rocuronium neuromuscular blockade following a previous rocuronium ⁄ sugammadex combination for two closely timed procedures [1]. The patient in question was 93-years-old and had acute renal failure.…”