Delayed recurarisation after sugammadex reversal

Bellod, Ana; March, Xavier; Hernández, Carmen; Villalonga, A

doi:10.1097/eja.0000000000000132

Cited by 13 publications

(8 citation statements)

References 5 publications

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“…Bellod et al, reported a case of delayed recurarisation after sugammadex reversal. The authors explained that event through either capturing or displacement reaction.…”

Section: Discussionmentioning

confidence: 99%

A comparison of sugammadex and neostigmine for reversal of rocuronium‐induced neuromuscular blockade in children

Ammar¹,

Mahmoud²,

Kasemy³

2017

Acta Anaesthesiol Scand

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“…Bellod et al, reported a case of delayed recurarisation after sugammadex reversal. The authors explained that event through either capturing or displacement reaction.…”

Section: Discussionmentioning

confidence: 99%

A comparison of sugammadex and neostigmine for reversal of rocuronium‐induced neuromuscular blockade in children

Ammar¹,

Mahmoud²,

Kasemy³

2017

Acta Anaesthesiol Scand

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“…13 However, Kotake et al, reported a 5% incidence of postoperative residual paralysis after reversal with sugammadex without neuromuscular monitoring, 14 and critical cases with recurarization after recovery with sugammadex are reported. [15][16][17][18][19] Notably, recurarization was reported in a 78-yr-old male with mild to moderate renal dysfunction receiving sugammadex 3.6 mg/kg after confirming train-of-four count 2 with a continuous neuromuscular monitor. 19 Despite its clinical importance, we lack knowledge of the mechanisms and risk factors of residual paralysis and recurarization after low-dose sugammadex administration.…”

Section: Editor's Perspective What We Already Know About This Topicmentioning

confidence: 97%

Differences of Recovery from Rocuronium-induced Deep Paralysis in Response to Small Doses of Sugammadex between Elderly and Nonelderly Patients

et al. 2018

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Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Complete recovery from rocuronium-induced muscle paralysis with sugammadex is reported to be delayed in elderly patients. The authors tested a hypothesis that recovery from deep neuromuscular block with low-dose sugammadex is slower (primary hypothesis) and incidence of recurarization is higher (secondary hypothesis) in elderly patients than in nonelderly patients. Methods In anesthetized elderly (n = 20; 76.9 ± 5.0 yr of age) and nonelderly patients (n = 20; 53.7 ± 12.8 yr of age) under deep paralysis with rocuronium, change of train-of-four ratio per minute (primary outcome variable) was measured with an acceleromyograph neuromuscular monitor during spontaneous recovery from rocuronium-induced muscle paralysis (0.6 mg/kg) and after infusion of low-dose sugammadex (50 µg · kg-1 · min-1). Recurarization was defined as the negative change of train-of-four ratio. Results Spontaneous train-of-four ratio recovery rate was significantly slower in the elderly group (median [25th percentile, 75th percentile]: 1.89 [1.22, 2.90] %/min) than in the nonelderly group (3.45 [1.96, 4.25] %/min, P = 0.024). Train-of-four ratio change rate in response to low-dose sugammadex was significantly slower in elderly (0.55 [–0.29, 1.54] %/min) than in the nonelderly group (1.68 [0.73, 3.13] %/min, P = 0.024). Incidence of recurarization was significantly higher in the elderly group than in the nonelderly group (35% vs. 5%, P = 0.044). Multiple linear regression analyses indicate that slower spontaneous train-of-four ratio recovery rate and impaired renal function are two major contributing factors that decrease train-of-four ratio change rate in response to low-dose sugammadex. Conclusions Elderly patients are at greater risk for recurarization and residual muscle paralysis when low-dose sugammadex is administered.

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“…Kotake et al reported an incidence of RNMB of 4.3% in patients receiving sugammadex without monitoring [20]. Additionally, several other cases have been documented in which sugammadex proved ineffective [21], had a prolonged onset of action [22][23][24], or resulted in recurrence of NMB when sugammadex was used without objective monitoring [25,26].…”

Section: Advances In Neuromuscular Blockade Pharmacologymentioning

confidence: 99%

Clinical Practice Guideline for the Management of Neuromuscular Blockade: What Are the Recommendations in the USA and Other Countries?

Nemes

Renew

2020

Curr Anesthesiol Rep

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Purpose of Review This review addresses various societal guidelines, standards, and consensus statements regarding optimal neuromuscular blockade management. We discuss the historical evolution of neuromuscular management as a means of identifying possible future trends. Recent Findings While a recent international panel of experts has called for abandoning clinical assessment and subjective evaluation using a peripheral nerve stimulator in favor of adopting quantitative monitoring, few anesthesia societies mandate similar practices at the moment. Summary The current status of neuromuscular monitoring in the world is still variable and unsatisfactory. Nevertheless, a positive trend can be observed in the anesthesia community to adopt and learn this neglected technique. The development of user-friendly monitoring devices should also help this process, but anesthesia national societies still need to do a lot to replace outdated and substandard practices.

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Delayed recurarisation after sugammadex reversal

Cited by 13 publications

References 5 publications

A comparison of sugammadex and neostigmine for reversal of rocuronium‐induced neuromuscular blockade in children

A comparison of sugammadex and neostigmine for reversal of rocuronium‐induced neuromuscular blockade in children

Differences of Recovery from Rocuronium-induced Deep Paralysis in Response to Small Doses of Sugammadex between Elderly and Nonelderly Patients

Clinical Practice Guideline for the Management of Neuromuscular Blockade: What Are the Recommendations in the USA and Other Countries?

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