Use of Sugammadex after Neostigmine Incomplete Reversal of Rocuronium-Induced Neuromuscular Blockade

Menezes, Cássio Campelo de; Peceguini, Lilian Akemi Moore; Silva, Enis Donizetti; Simões, Cláudia Marquez

doi:10.1016/s0034-7094(12)70153-8

Cited by 17 publications

(17 citation statements)

References 13 publications

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“…4.1 and 4.2). Sugammadex may also have potential for the rescue of residual neuromuscular blockade if reversal with an AChE inhibitor is incomplete [69,70], and low-dose sugammadex (i.e. \2 mg/kg) successfully reversed shallow, residual, rocuronium-induced neuromuscular blockade [71][72][73].…”

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confidence: 99%

Sugammadex: A Review of Neuromuscular Blockade Reversal

Keating

2016

Drugs

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Sugammadex (Bridion(®)) is a modified γ-cyclodextrin that reverses the effect of the steroidal nondepolarizing neuromuscular blocking agents rocuronium and vecuronium. Intravenous sugammadex resulted in rapid, predictable recovery from moderate and deep neuromuscular blockade in patients undergoing surgery who received rocuronium or vecuronium. Recovery from moderate neuromuscular blockade was significantly faster with sugammadex 2 mg/kg than with neostigmine, and recovery from deep neuromuscular blockade was significantly faster with sugammadex 4 mg/kg than with neostigmine or spontaneous recovery. In addition, recovery from neuromuscular blockade was significantly faster when sugammadex 16 mg/kg was administered 3 min after rocuronium than when patients spontaneously recovered from succinylcholine. Sugammadex also demonstrated efficacy in various special patient populations, including patients with pulmonary disease, cardiac disease, hepatic dysfunction or myasthenia gravis and morbidly obese patients. Intravenous sugammadex was generally well tolerated. In conclusion, sugammadex is an important option for the rapid reversal of rocuronium- or vecuronium-induced neuromuscular blockade.

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confidence: 99%

Sugammadex: A Review of Neuromuscular Blockade Reversal

Keating

2016

Drugs

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“…Rocuronium is a steroidal nondepolarizing muscle relaxant with duration of action ranging from 38 to 150 mins [8]. The surgical procedure was over in 81 mins and the patient was reversed with a standard dose of neostigmine and glycopyrrolate.…”

Section: Discussionmentioning

confidence: 99%

Management of Residual Neuromuscular Blockade Recovery: Age-Old Problem with a New Solution

Green

Venkatesh

Venkataramani

2017

Case Reports in Anesthesiology

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Neostigmine has been traditionally used as the agent of choice to reverse Neuromuscular Blockade (NMB) after muscle paralysis during general anesthesia. However, the use of neostigmine has not been without untoward events. Sugammadex is a novel drug that selectively binds to aminosteroid nondepolarizing muscle relaxants and reverses even a deep level of NMB. Controversy exists regarding the optimal dose of sugammadex that is effective in reversing the NMB after the incomplete reversal with neostigmine and glycopyrrolate. We discuss a case where sugammadex reduced the time of the recovery from NMB in a patient who had incomplete antagonisms following adequate treatment with neostigmine, aiding timely extubation without persistent residual NMB, and hence prevented the requirement of postoperative ventilation and the improvement in patient care. More randomized control studies are needed in order to conclude the appropriate dose of sugammadex in cases of incomplete reversal.

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“…It has been shown previously that the reversal of NMB with anticholinesterase drugs may not be complete after a large dose of a neuromuscular blocking agent [14]. Sugammadex resolved the residual NMB within 2 min, even after reversal with anticholinesterase agents, and is a safe alternative to reversal of NMB induced by steroidal non-depolarizing agents [15]. In this case, deep rocuronium-induced NMB can be reversed successfully with sugammadex at doses of 2 mg/kg and in as little as 2 min.…”

Section: Discussionmentioning

confidence: 99%

The use of 3 sugammadex out of 5 reversal of during recovery of rocuronium-induced neuromuscular blockade in a patient with post-tonsillectomy hemorrhage: a case report

Lee

Kim

et al. 2014

Korean J Anesthesiol

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Post-tonsillectomy hemorrhage (PTH) is the most frequent complication of tonsillectomy, and occasionally results in a lethal outcome. A 21-year-old man (height 180 cm, weight 95 kg) was scheduled for a bilateral tonsillectomy and uvulopalatopharyngoplasty for treatment of obstructive sleep apnea. He required 5 rounds of general anesthesia due to recurrent PTH. The anesthesiologist used sugammadex a total of 3 times to achieve the successful reversal of the deep neuromuscular blockade (NMB) induced by rocuronium. After sugammadex 2 mg/kg was administered, the NMB was reversed in 2 minutes each time. Re-administration of rocuronium within a short time interval after sugammadex may result in unpredictable effects of neuromuscular blocking agents. Sugammadex made it possible to perform a rapid, complete reverse when the residual block was maintained by an incomplete reversal of anticholinesterase.

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Use of Sugammadex after Neostigmine Incomplete Reversal of Rocuronium-Induced Neuromuscular Blockade

Cited by 17 publications

References 13 publications

Sugammadex: A Review of Neuromuscular Blockade Reversal

Sugammadex: A Review of Neuromuscular Blockade Reversal

Management of Residual Neuromuscular Blockade Recovery: Age-Old Problem with a New Solution

The use of 3 sugammadex out of 5 reversal of during recovery of rocuronium-induced neuromuscular blockade in a patient with post-tonsillectomy hemorrhage: a case report

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