A Miracle That Accelerates Operating Room Functionality: Sugammadex

Abstract

Background. Sugammadex offers a good alternative to the conventional decurarisation process currently performed with cholinesterase inhibitors. Sugammadex, which was developed specifically for the aminosteroid-structured rocuronium and vecuronium neuromuscular blockers, is a modified cyclodextrin made up of 8 glucose monomers arranged in a cylindrical shape. Methods. In this study, the goal was to investigate the efficacy of sugammadex. Sugammadex was used when there was insufficient decurarisation following neostigmine. This study was performed on 14 patients who experienced insufficient decurarisation (TOF <0.9) with neostigmine after general anaesthesia in the operating rooms of a university and a state hospital between June, 2012, and January, 2014. A dose of 2 mg/kg of sugammadex was administered. Results. Time elapsed until sugammadex administration following neostigmine 37 ± 6 min, following sugammadex it took 2.1 ± 0.9 min to reach TOF ≥0.9, and the extubation time was 3.2 ± 1.4 min. No statistically significant differences were detected in the hemodynamic parameters before and after sugammadex application. From the time of administration of sugammadex to the second postoperative hour, no side effects or complications occurred. None of the patients experienced acute respiratory failure or residual block during this time period. Conclusion. Sugammadex was successfully used to reverse rocuronium-induced neuromuscular block in patients where neostigmine was insufficient.

Investigation of potential neuropharmacological activity of neostigmine‐glycopyrrolate for intraoperative neural monitoring in thyroid surgery

“…Sugammadex, a selective relaxant‐binding agent, was specifically developed for rapid reversal of rocuronium‐induced NMB 22 . By selectively binding to NMB agents, sugammadex inactivates free NMB agents in the plasma, resulting in a large concentration gradient of NMB agent molecules between the neuromuscular junction and the plasma, leading to decreased NMB agents at the neuromuscular junction end plate 23 .…”

Sugammadex facilitates early recovery after surgery even in the absence of neuromuscular monitoring in patients undergoing laryngeal microsurgery: a single-center retrospective study

“…Since its introduction, sugammadex showed marked efficacy and safety, ringing in a new era of patient safety in anaesthesiology [ 7 ]. However, since its dosing regimen necessitates the use of neuromuscular monitoring, the use of this agent may be limited in certain situations, particularly where such monitoring devices are not routinely used.…”

“…Sugammadex has been demonstrated to shorten the time to reach a train-of-four ratio of 0.9 as well as the extubation time, resulting in improvement of operating room turnover in clinical anaesthesia settings, including neuromuscular monitoring [ 6 , 7 ]. Therefore, sugammadex may be a useful factor for the enhanced recovery after surgery (ERAS) protocol [ 8 ].…”

Monitorización intraoperatoria del bloqueo neuromuscular y la presión arterial con un solo dispositivo (TOF-Cuff): estudio comparativo con la mecanomiografía y la presión arterial invasiva

“…Aún así, se alternó la administración de sugammadex y neostigmina en todos los pacientes, de forma que la mitad recibieron un fármaco reversor y la otra mitad el otro. En los pacientes en que se utilizó neostigmina se obtuvieron un mayor número de pares de medidas durante la fase de recuperación del BNM respecto a aquellos pacientes en los que se utilizó sugammadex, puesto que el tiempo de reversión (tiempo desde la administración del reversor hasta la recuperación de un TOF-ratio > 0.9), es 5 veces más rápido con sugammadex que con neostigmina 151,152 . La medición del TOFratio durante toda la intervención se realizaba cada 15 segundos según el programa de estimulación utilizado, por lo que durante la fase de bloqueo superficial (TOF ≥ 4) el número mínimo de medidas obtenidas, incluso administrando sugammadex como agente reversor, fue de 10, que era el objetivo del estudio.…”