Use of sugammadex in patients with neuromuscular disorders: a systematic review of case reports

Abstract

Background: Sugammadex is a modified gamma-cyclodextrin that acts by selectively encapsulating free aminosteroidal neuromuscular relaxants. Several case reports have been published on the use of sugammadex in patients with neuromuscular disorders that include neuromuscular junction diseases, myopathies, neuropathies, and motor neurone disorders. The primary aim of this review is to systematically review the evidence on the use of sugammadex in patients with this heterogeneous group of diseases and provide recommendations for clinical practice. Methods: A systematic electronic search of Medline, Embase and CINAHL databases was done until June 2019, to identify case reports describing the use of sugammadex in adult surgical patients with neuromuscular disorders. Results: Of the 578 records identified through database searches, 43 articles were finally included for the systematic review. Of these, 17 reports were on patients with myopathy, 15 reports on myasthenia gravis, 9 reports on motor neuron diseases and 2 reports on neuropathies. Conclusions: Majority of the articles reviewed report successful use of sugammadex to reverse steroidal muscle relaxants, especially rocuronium, in patients with neuromuscular diseases. However, with sugammadex, unpredictability in response and uncertainty regarding optimum dose still remain issues. Quantitative neuromuscular monitoring to ensure complete reversal and adequate postoperative monitoring is strongly recommended in these patients, despite the use of sugammadex.

Adverse events of sugammadex that occurred in a Korean population

“…In both cases, sugammadex was administered at TOF 0, and the time to extubation after sugammadex administration was 15.6 min and 15 min, respectively. However, the presence of neuromuscular diseases does not necessarily cause delayed recovery [ 28 ], and although rare, delayed recovery may occur in healthy patients [ 29 ]. Since these patients may also experience additional adverse events due to excessive sugammadex, determining the appropriate dose of sugammadex through quantitative neuromuscular monitoring will help prevent adverse events.…”

General anesthesia with remimazolam in a patient with mitochondrial encephalomyopathy: a case report

“…In our patient, we did not administer sugammadex because the TOF ratio was ≥ 0.9 [12] and the effects of sugammadex in patients with muscular disease and TOF ratio ≥ 0.9 have not been investigated. Furthermore, sugammadex administration is associated with risks such as difficulty with reintubation and allergic reaction [13]. Therefore, the decision to use sugammadex should be considered carefully.…”

Endotracheal Intubation Using Alfentanil in a Pediatric Patient with a Mitochondrial Myopathy and Gastroparesis

“…In addition, sugammadex is not readily available at all institutions and its use may be hindered by higher costs. 10 Alfentanil has been studied as a replacement for neuromuscular blockade for endotracheal intubation in combination with propofol or inhaled anesthetics. 11 One author found optimal intubating conditions using 0.15 μg/kg alfentanil in combination with 4 mg/kg propofol.…”