Clinical implications of sugammadex

Abstract

SummarySugammadex is a cyclodextrin molecule that encapsulates and inactivates rocuronium and vecuronium. As a result, any degree of neuromuscular block produced by rocuronium or vecuronium can be rapidly and completely reversed without autonomic effects. Because sugammadex is optimised for reversing rocuronium it is most likely to be used in conjunction with this drug. Sugammadex will allow deep levels of block to be maintained until the very end of surgery, and will allow block to be reversed at any time after rocuronium administration, even just a few minutes. The recommended dose-range is 2-16 mg.kg-1 (ascender), depending on the level of block. The availability of sugammadex reversal may increase the use of rocuronium, and decrease the use of suxamethonium and benzylisoquinoline neuromuscular blocking drugs. In addition, it will certainly increase pharmacy costs, which may be offset by faster recovery and discharge from the postanesthesia recovery unit. Sugammadex may also change monitoring practices in that post-tetanic count will be required to quantify deep block, and quantitative monitoring of recovery may be driven by cost concerns in order to allow the use of the smallest dose of sugammadex that gives a satisfactory train-of-four ratio. Alternatively, monitoring may essentially be abandoned since a large dose of sugammadex will reliably reverse any degree of rocuronium-induced block. The ultimate clinical utility of sugammadex will be clear only after large-scale clinical use.

Calabadion

“…10,11 To date, acetylcholinesterase inhibitors are most frequently used for reversal of NMBA, 10,12 but due to their indirect mode of action their ability to reverse profound residual neuromuscular blockade induced by a high concentration of muscle relaxants is limited 13,14 and they have undesirable muscarinergic side effects. 15,16 Sugammadex 17 reverses any degree of vecuronium-or rocuronium-induced block 18,19 by encapsulating the drug and thereby inactivating it, but the drug has not yet been approved by the Food and Drug Administration because concerns related to allergic reactions and hemorrhagic side effects need to be addressed before resubmission. In addition, despite its ability to reverse all levels of steroidal neuromuscular blockade, sugammadex does not reverse residual neuromuscular blockade induced by benzylisoquinolines.…”

Effect of Labetalol and Esmolol on Onset of Action of Rocuronium: A Prospective Double-Blinded Randomized Controlled Trial

“…The main drawback compared with succinylcholine is its much longer duration of action which restricts its use in a difficult airway scenario. A newly introduced drug called sugammadex [14,15] is a specific rocuronium antagonist, which reliably reverses the muscle relaxation produced by rocuronium given within minutes of rocuronium. This new drug now allows rocuronium to be reliable use in difficult airway scenario without worrying about the recovery of muscle power.…”

Our love-hate relationship with succinylcholine: Is sugammadex any better?

“…15 This is exciting news for the anesthesia community, since we now have a drug that can quickly reverse the effect of high-dose rocuronium required for RSI-it potentially allows us to stop using succinylcholine. 16,17 Following the introduction of sugammadex, we recently sought to determine its impact on the clinical use of succinylcholine by informally soliciting information from colleagues in ten countries around the globe (Australia, Germany, Italy, Malaysia, New Zealand, Saudi Arabia, Singapore, Switzerland, United Kingdom, and Venezuela) and focusing solely on the issue of RSI. Four questions were asked: 1) Do you still employ RSI?…”

“…14 15 Ces nouvelles sont réjouissantes pour la communauté de l'anesthésie, étant donné que nous disposons désormais d'un médicament qui peut rapidement neutraliser l'effet des fortes doses de rocuronium nécessaires à l'ISR -et il nous permettra peut-être d'arrêter d'utiliser la succinylcholine. 16,17 Suite à l'introduction du sugammadex, nous avons récemment tenté de déterminer son impact sur l'utilisation clinique de la succinylcholine en demandant de l'information, de façon informelle, à nos collègues de dix pays dans le monde entier (Australie, Allemagne, Italie, Malaisie, Nouvelle-Zélande, Arabie saoudite, Singapour, Suisse, Royaume-Uni et Venezuela) et en nous concentrant exclusivement sur la question de l'ISR. Nous leur avons posé quatre questions : 1) Employez-vous toujours l'ISR?…”