SummaryRecent studies have shown that the use of high dose rocuronium followed by sugammadex provides a faster time to recovery from neuromuscular blockade following rapid sequence induction than suxamethonium. In a manikin-based 'cannot intubate, cannot ventilate' simulation, we studied the total time taken for anaesthetic teams to prepare and administer sugammadex from the time of their initial decision to use the drug. The mean (SD) total time to administration of sugammadex was 6.7 (1.5) min, following which a further 2.2 min (giving a total 8.9 min) should be allowed to achieve a train-of-four ratio of 0.9. Four (22%) teams gave the correct dose, 10 (56%) teams gave a dose that was lower than recommended, four (22%) teams gave a dose that was higher than recommended, six (33%) teams administered sugammadex in a single dose, and 12 (67%) teams gave multiple doses. Our simulation highlights that sugammadex might not have saved this patient in a 'cannot intubate, cannot ventilate' situation, and that difficulties and delays were encountered when identifying, preparing and administering the correct drug dose. The first clinical use of sugammadex in humans to reverse neuromuscular blockade induced by rocuronium was reported in 2005 [1]. Since then, sugammadex has been shown to be clinically effective [2] and has become available for clinical use in hospitals throughout Europe [3]. Since its introduction into clinical practice, the role of sugammadex in rapid sequence induction has been investigated. In a recent review, no statistical difference in intubating conditions was found when suxamethonium was compared to high dose (1.2 mg.kg )1 ) rocuronium administration during rapid sequence induction [4]. The main advantage of suxamethonium over rocuronium is the faster spontaneous recovery from neuromuscular blockade that occurs following the former's use; this characteristic has been a main indication for using suxamethonium despite its possible severe side-effects [5]. The possibility of rapidly reversing the effects of rocuronium has raised the question of whether suxamethonium is still necessary in clinical practice [6,7]. High dose rocuronium administration can provide fast neuromuscular blockade that permits early tracheal intubation comparable to that found when using suxamethonium [8,9]. Lee et al. [10] found that the intravenous administration of 16 mg.kg )1 sugammadex, 3 min after giving 1.2 mg.kg )1 rocuronium, resulted in reversal of neuromuscular blockade that was faster than the spontaneous recovery following 1 mg.kg )1 suxamethonium.Sugammadex has the potential to provide early reversal of profound neuromuscular blockade should a 'cannot intubate, cannot ventilate' situation arise following induction of anaesthesia [11]. However, as it still takes 2.2 min for the train-of-four (TOF) ratio (the ratio of magnitudes of the fourth to the first twitches) to recover to 0.9 following administration of sugammadex, the margin of safety is narrow in the event of failed tracheal intubation with inability to vent...

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Nach Einf?hrung von Sugammadex wird Rocuronium alternativ zu Succinylcholin zur Durchf?hrung der Rapid-Sequence-Induction (RSI) verwendet. Daf?r m?ssen allerdings nicht nur Anschlagszeit und Intubationsbedingungen, sondern auch die R?ckkehr der neuromuskul?ren Erregbarkeit vergleichbar sein. S?rensen und Kollegen haben dies in einer randomisierten Doppelblindstudie demonstriert.