Zastosowanie sugammadeksu do odwracania bloku nerwowo-mięśniowego wywołanego wekuronium po operacjach wewnątrzczaszkowych

Karwacki, Zbigniew; Niewiadomski, Seweryn; Rzaska, Marta

doi:10.5603/ait.2015.0042

Cited by 3 publications

(1 citation statement)

References 23 publications

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“…The body of evidence enrolling adults included 191 studies (133 randomized controlled trials, 4,59–90,92,95,98–104,110–114,118–127,132–141,145–148,155–157,163,173–181,206–254 11 nonrandomized trials, 17,128,142,182–184,191,255–258 45 cohort studies, 15,42,86,91,93,94,96,97,105–109,116,117,129–131,143,144,186–190,227,259–277 and 2 before–after designs 115,168 ) evaluating efficacy and safety of antagonist drugs for neuromuscular blockade. The randomized controlled trials enrolling only adults had a median of 88 participants (range, 16 to 350).…”

Section: Antagonism Of Neuromuscular Blockadementioning

confidence: 99%

2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade: A Report by the American Society of Anesthesiologists Task Force on Neuromuscular Blockade

Thilen¹,

Weigel²,

Todd³

et al. 2023

Anesthesiology

114

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Section: Antagonism Of Neuromuscular Blockadementioning

confidence: 99%

2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade: A Report by the American Society of Anesthesiologists Task Force on Neuromuscular Blockade

Thilen¹,

Weigel²,

Todd³

et al. 2023

Anesthesiology

114

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The impact of sugammadex dosing and administration practices on potential cost savings for pharmacy departments

Linn,

Renew

2024

American Journal of Health-System Pharmacy

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Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Neuromuscular blocking agents (NMBAs) are commonly used during surgery, and restoring neuromuscular function at the end of surgery is vital in preventing complications of residual paralysis. Recent guidelines from the American Society of Anesthesiology recommend using sugammadex over neostigmine; however, sugammadex is significantly more expensive than neostigmine and may increase drug expenditure for pharmacy departments. This review summarizes evidence evaluating sugammadex dose adjustments and the potential of these dose adjustments to lead to cost savings for pharmacy departments. Summary We found evidence suggesting that the manufacturer-recommended sugammadex dose may not be needed in many patients and that dosing based on an adjusted body weight or based on depth of neuromuscular blockade may lead to lower sugammadex usage. Combining sugammadex with neostigmine could also decrease the dose of sugammadex required. We have highlighted the importance of objective neuromuscular monitoring to guide sugammadex dosing and evaluation for residual neuromuscular blockade. Cost savings for pharmacy departments may be realized by these alternative dosing strategies and/or vial-splitting practices. Conclusion Implementing practices related to sugammadex vial splitting and dose adjustment based on body weight and depth of neuromuscular blockade shows potential benefits in terms of sugammadex cost savings.

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Opioid-free general anesthesia in patient with Steinert syndrome (myotonic dystrophy)

Gaszyński¹

2016

Medicine

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Introduction:We report on the anesthetic management using opioid-free method of a patient with Steinert syndrome (myotonic dystrophy, MD), autosomal dominant dystrophy which is characterized by consistent contracture of muscle following stimulation. A myotonic crisis can be induced by numerous factors including hypothermia, shivering, and mechanical or electrical stimulation. In patients with MD, hypersensitivity to anesthetic drugs, especially muscle relaxants and opioids, may complicate postoperative management. If opioids are employed (systemic or neuraxial), then ICU care and continuous pulse oximetry must be considered given the high risk for respiratory depression and aspiration. Patients with MD present high sensitivity to the usual anesthetics such as volatile and muscle relaxants (both depolarizing and nondepolarizing). Opioids may induce muscle rigidity in this type of MD. Therefore, omitting opioids is recommended. Due to hypersensitivity to opioids and increased susceptibility to intra- and postoperative complications, it is recommended to introduce opioid-free anesthesia (OFA), for example, with use of dexmedetomidine (DEX). This is a new method of conducting general anesthesia without opioids and is based on concept of multimodal approach to pain management.Methods:A 31-year-old male patient (183 cm, 69 kg) was scheduled for laparoscopic operation of cholecystectomy. The patient received intravenously (IV): propofol in a dose of 250 mg followed by continuous infusion, rocuronium in a dose of 20 mg, and DEX in a loading dose of 0.6 μg/kg over 10 minutes followed by continuous infusion of dose of 0.2 μg/kg/hour.Results:The course of anesthesia and postoperative period were uneventful. The patient exited the operating theatre in a good medical state, with vitals within normal limits and fully regained consciousness.Conclusion:DEX is effective and safe for moderately painful procedures in patients with the elevated risk of respiratory and cardiovascular failure. This substance provides adequate analgesia level during surgeries of patients suffering from MD.

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Zastosowanie sugammadeksu do odwracania bloku nerwowo-mięśniowego wywołanego wekuronium po operacjach wewnątrzczaszkowych

Cited by 3 publications

References 23 publications

2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade: A Report by the American Society of Anesthesiologists Task Force on Neuromuscular Blockade

2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade: A Report by the American Society of Anesthesiologists Task Force on Neuromuscular Blockade

The impact of sugammadex dosing and administration practices on potential cost savings for pharmacy departments

Opioid-free general anesthesia in patient with Steinert syndrome (myotonic dystrophy)

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