Neuromuscular blockers and reversal agents and their impact on anesthesia practice

Zafirova, Zdravka; Dalton, Allison

doi:10.1016/j.bpa.2018.06.004

Cited by 17 publications

(19 citation statements)

References 51 publications

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“…[23][24][25][26] Reversal of neuromuscular blockade is frequently required through the use of acetylcholinesterase inhibitors, most commonly neostigmine, which has been in continuous use since the 1950s. 30,31 However in December 2015, the US Food and Drug Administration approved sugammadex for use in reversing neuromuscular blockade induced by either rocuronium or in adults. 32 Sugammadex is a modified gamma-cyclodextrin ring with a central core to bind either rocuronium or vecuronium.…”

Section: Discussionmentioning

confidence: 99%

“…9,14 John and colleagues reported improved OR discharge times with sugammadex, an interval mean decrease of 2.7 (95% CI, 0.2-5.2) minutes. 9 Carron and colleagues reported an interval mean decrease of 22 (95% CI, [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] minutes in OR discharge times, as well as an improvement in PACU recovery times (approximately 17 minutes) with sugammadex. 14 In our study, we did not observe these OR discharge or PACU recovery time savings using equivalence testing methods, 22 as both 90% CIs for sugammadex were above the targets set for neostigmine.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Perioperative Efficiency of Sugammadex Following Laparoscopic Cholecystectomy in Clinical Practice

Lee¹,

Ahsan²,

Chae³

et al. 2022

TOJ

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Background: Studies have proposed that the routine use of the modified gamma-cyclodextrin, sugammadex, could provide perioperative time savings. However, these investigations have been limited to small group analyses. The purpose of this study was to test the effectiveness of sugammadex on perioperative times when compared to neostigmine under general clinical practice conditions following rocuronium-induced neuromuscular blockade for laparoscopic cholecystectomy. Methods: Following institutional review board approval, data from 1,611 consecutive surgical records for laparoscopic cholecystectomy were reviewed. Patient characteristics, type of primary neuromuscular blocking reversal agent, operating room (OR) discharge times, and postanesthesia care unit (PACU) recovery times were the measures of interest. Equivalence testing was used to determine the between-group differences of the reversal agents in the two perioperative time periods of interest. Results: OR discharge times averaged 10.9 (95% CI, 10-11.8) minutes for patients administered sugammadex and 8.9 (95% CI, 8.2-9.7) minutes for patients administered neostigmine. PACU recovery times averaged 77.6 (95% CI, 74.1-81.1) minutes for sugammadex and 68.6 (95% CI, 65.9-71.3) minutes for neostigmine. Equivalence testing demonstrated no improvement in the two perioperative times with sugammadex. Conclusion: These results suggest no perioperative time savings with sugammadex when compared to neostigmine following laparoscopic cholecystectomy under general clinical practice conditions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Perioperative Efficiency of Sugammadex Following Laparoscopic Cholecystectomy in Clinical Practice

Lee¹,

Ahsan²,

Chae³

et al. 2022

TOJ

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“…Various drugs, such as succinylcholine and other neuromuscular blocking agents, affect the NMJ [ 29 ]. However, treatment options for NMJ diseases are mostly limited to acetylcholinesterase (AChE) inhibitors and immunosuppressive therapies.…”

Section: Treatment Modalities In Nmjmentioning

confidence: 99%

Effects of Natural Products on Neuromuscular Junction

Akkol

Karatoprak

Carpar³

et al. 2022

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: Neuromuscular junction (NMJ) disorders result from damage, malfunction or absence of one or more key proteins involved in neuromuscular transmission, comprising a wide range of disorders. The most common pathology is antibody-mediated or downregulation of ion channels or receptors, resulting in Lambert-Eaton myasthenic syndrome, myasthenia gravis, and acquired neuromyotonia (Isaac’s syndrome), and rarely congenital myasthenic syndromes caused by mutations in NMJ proteins. A wide range of symptomatic treatments, immunomodulating therapies, or immunosuppressive drugs have been used to treat NMJ diseases. Future research must be directed at better understanding of the pathogenesis of these diseases, and developing novel disease-specific treatments. Numerous secondary metabolites, especially alkaloids isolated from plants have been used to treat NMJ diseases in traditional and clinical practices. An ethnopharmacological approach has provided leads for identifying new treatment for NMJ diseases. In this review, we performed a literature survey in Pubmed, Science Direct, and Google Scholar to gather information on drug discovery from plant sources for NMJ disease treatments. To date, most research has focused on the effect of herbal remedies on cholinesterase inhibitory and antioxidant activities. This review provides leads for identifying potential new drugs from plant sources for the treatment of NMJ diseases.

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“…Currently, medications that provide a neuromuscular block (NMB) are routinely administered in major surgeries and procedures to facilitate airway intubation and maintain surgical status (Zafirova & Dalton, 2018 ; Stauble & Blobner, 2020 ). Although reversal agents are applied to eliminate NMB after surgery, residual NMB may remain and has been associated with an increased risk of postoperative pulmonary complications (PPCs), such as hypoxia, atelectasis, pulmonary infection, etc.…”

Section: Introductionmentioning

confidence: 99%

Influence of sugammadex versus neostigmine for neuromuscular block reversal on the incidence of postoperative pulmonary complications: a meta-analysis of randomized controlled trials

Wang

Zhao²,

Jiang

et al. 2021

Perioper Med

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Background The influence of sugammadex for reversal of neuromuscular block (NMB) on postoperative pulmonary complications (PPCs), compared with neostigmine, remains to be determined. We performed a meta-analysis of randomized controlled trials (RCTs) to compare the incidence of PPCs between patients who received sugammadex versus neostigmine. Methods Relevant studies were obtained by searching the PubMed, Embase, and Cochrane Library databases. A random effects model incorporating the potential heterogeneity was used to pool the results. Results Fourteen RCTs including 1478 adult patients who underwent surgeries with general anesthesia were included, and of these, 753 received sugammadex and 725 received neostigmine for reversal of NMB. The pooled results showed that sugammadex was associated with a lower risk of overall PPCs compared to neostigmine (odds ratio [OR]: 0.62, 95% confidence interval [CI]: 0.43–0.89, p = 0.01; I2 = 0%). This finding remained consistent after exclusion of two studies with potential overlapping events (OR: 0.58, 95% CI: 0.36–0.96, p = 0.03; I2=9%). Stratified analyses according to the categories of PPCs showed that sugammadex was associated with a significantly lower risk of postoperative respiratory failure (OR: 0.60, 95% CI: 0.38–0.97, p = 0.04; I2 = 0%) but not of postoperative pulmonary infection (OR: 0.79, p = 0.71), atelectasis (OR: 0.78, p = 0.33), or pneumothorax (OR: 0.87, p = 0.79). Conclusions Compared with neostigmine, the use of sugammadex for reversal of NMB was associated with a lower risk of PPCs, mainly due to a lower incidence of postoperative respiratory failure with the use of sugammadex.

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Neuromuscular blockers and reversal agents and their impact on anesthesia practice

Cited by 17 publications

References 51 publications

Perioperative Efficiency of Sugammadex Following Laparoscopic Cholecystectomy in Clinical Practice

Perioperative Efficiency of Sugammadex Following Laparoscopic Cholecystectomy in Clinical Practice

Effects of Natural Products on Neuromuscular Junction

Influence of sugammadex versus neostigmine for neuromuscular block reversal on the incidence of postoperative pulmonary complications: a meta-analysis of randomized controlled trials

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