Dialysability of sugammadex and its complex with rocuronium in intensive care patients with severe renal impairment

Abstract

Haemodialysis using a high-flux dialysis method is effective in removing sugammadex and the sugammadex-rocuronium complex in patients with severe renal impairment.

The effects of low and high doses of sugammadex on kidney tissue in streptozotocin-induced diabetic rats

“…In renal failure state, much longer elimination time of sugammadex plus rocuronium complex was found although Staals et al could not show any level of recurarization after 48 hours of sugammadex administration (16). Additionally, the effi cacy of sugammadex in patients with renal failure was found to be similar to that in inpatients with normal GFR and renal functions (6). For another special patient group, the elderly, there is no recommended sugammadex dose regulation.…”

“…Sugammadex is primarily (> 90 %) excreted in the urine in an unchanged state within 48 hours after intravenous administration (4,5). In patients with renal failure, sugammadex clearance is decreased while half-life and volume of distribution are increased (6).…”

Sugammadex: A neuromuscular blockade agent encapsulator

“…Therefore, at this time standard dosing continues to be based on weight and train of four twitches as outlined in the Hepatic metabolism is responsible for rocuronium and vecuronium clearance; renal clearance regulates the sugammadex-NMBA complex elimination. 10,[18][19][20][21][22][23][24] In healthy kidneys with a glomerular filtration rate (GFR) of 75-120 ml/min, 70% of the dose is excreted in six hours, and 80-90% in 24 hours. 21,25,26 In renal failure, with GFR <30ml/min, only 29% of the dose administered is cleared by 72 hours.…”

“…24 The use of high-flux dialysis removes the bound sugammadex, but at this time sugammadex administration is not recommended for patients with severe renal dysfunction. 16,18,23,24 clinicAl ApplicAtions Sugammadex has many advantages when compared to the administration of neostigmine or no reversal agent at all. On average, dose-dependent intravenous administration of sugammadex results in full reversal of NMB within three minutes, even in circumstances of deep neuromuscular block, and avoids the possibility of recurarization.…”

Sugammadex: An Update

“…However, in renal failure patients, sugammadex-encapsulated rocuronium complex is detectable in plasma seven days after administration. High-flux haemodialysis is effective in removing the sugammadex-encapsulated rocuronium complexes [13].…”