Org 25969 (sugammadex), a selective relaxant binding agent for antagonism of prolonged rocuronium-induced neuromuscular block

Shields, M.; Giovannelli, Morena; Mirakhur, R. K.; Moppett, I. K.; Adams, Jonathan; Hermens, Y.

doi:10.1093/bja/aei314

Cited by 168 publications

(116 citation statements)

References 27 publications

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“…TOF 0,9'a ulaşma süreleri sırasıyla 6,4; 2,4; 2,3; 1,4; 1,2 dakika bulunmuştur. Çalışmanın sonuçlarına göre doz ile orantılı olarak sugammadeksin TOF 0,9'a ulaştırma süresi kısalmaktadır (12).…”

Section: Discussionunclassified

Comparison of Sugammadex and Neostigmine in Terms of Time to Extubation in Pediatrics

Güzelce¹,

Kendigelen²,

Tütüncü³

et al. 2016

Haseki

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ÖzAmaç: Sugammadeks rezidüel nöromüsküler bloğun kısa sürede tam olarak geri dönüşünü sağlayan siklodekstrin grubu bir ilaçtır. Bu çalışmada sugammadeks ve neostigminin dörtlü uyarı (Train of Four -TOF) 0,9 oranına ulaşma zamanı ve ekstübasyon süreleri (TE) değerlendirildi.Yöntemler: Alt üriner sistem veya inguinal herni cerrahisi geçiren, akciğer hastalığı, nöromüsküler hastalığı olmayan 37 hasta, iki gruba ayrılarak çalışmaya dahil edildi. Hastalar cerrahi operasyon sonunda nöromüsküler monitorizasyon yapılarak ekstübe edildi. Grup neostigmin (grup N): Cerrahi operasyon bitiminde TOF 2 olduğunda, intravenöz 0,05 mg/kg neostigmin uygulandı. Grup sugammadeks (grup S): Cerrahi operasyon bitiminde TOF 2 olduğunda, intravenöz 2 mg/kg sugammadeks uygulandı, TOF ≥0,9 ulaşma süresi (T0,9) ve antagonist enjeksiyonunda ekstübasyona kadar geçen süre kaydedildi. Parametreler istatistiksel olarak değerlendirildi. Bulgular:Grup N'deki olgularda TE 6,06±2,47 dakika, grup S'deki olgularda TE 4,30±2,48 dakika olarak saptandı (p<0,041).Sonuç: Sugammadeksin, neostigmine göre daha kısa sürede nöromüsküler bloğu ortadan kaldırdığı saptandı. Ölçüm zamanlarının hiçbirinde hemodinamik bakımdan ve komplikasyonlar açısından ciddi bir değişiklik saptanmadı. Fakat çocuklarda ilacın güvenilirliği ve yan etkilerinin değerlendirilmesi açısından sınırlı sayıda çalışma mevcuttur ve ilacın klinik uygulamasındaki güvenilirliği için daha çok çalışmaya ihtiyaç vardır. Anahtar Sözcükler: Sugammadeks, neostigmin, nöromüsküler blok, pediatrikAim: Sugammadex is a cyclodextrin compound which provides complete recovery of residual neuromuscular blockade. In this study, we compared sugammadex and neostigmine in terms of time to achieve a train-of-four (TOF) ratio of 0.9 and extubation time (TE). Methods:Thirty-seven patients, without lung disease and neuromuscular disease undergoing lower urinary tract surgery and inguinal hernia, were included in the study. Noninvasive arterial pressure, heart rate, pulse oximetry, and TOF-watch SX values were monitored during the surgery and, these parameters were recorded. After the surgery was completed, the patients were randomized into two groups: patients received either group neostigmine (group N) 0.05 mcg/kg and group sugammadex (group S) 2 mg/kg at reappearance of TOF ratio T2. Time to recovery to the TOF ratio of 0.9 (T0.9) and TE were compared between sugammadex and neostigmine Results:TE was found to be statistically longer in group N (6.06±2.47 minute) than in group S (4.30±2.48 minute) (p<0.041). Conclusion:We observed that sugammadex was more rapidly and effectively reversed the neuromuscular blockade compared to neostigmine. There were no serious adverse effects and significant hemodynamic changes in any measurement time. However, there is a limited number of studies on the safety and side effects of sugammadex in pediatric patients and additional data are needed to establish the safety in clinical practice.

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Section: Discussionunclassified

Comparison of Sugammadex and Neostigmine in Terms of Time to Extubation in Pediatrics

Güzelce¹,

Kendigelen²,

Tütüncü³

et al. 2016

Haseki

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“…Shields M ve ark. [8] yaptığı bir çalışmada; rokuronyumla sağla-nan nöromusküler bloğun kaldırılmasında farklı dozlarda sugammadeks karşılaştırılmıştır. Otuz hasta üzerinde yapılan çalışma-da hastalara başlangıçta 0,6 mg/kg rokuronyum verilmiş, en az iki saat boyunca PTC <10 olacak şekilde derin blok sağlanmış, sonrasında TOF 2 olması beklenerek 0,5mg/kg, 1mg/kg, 2mg/ kg, 4mg/kg, 6mg/kg sugammadeks verilmiş, TOF oranı 0,9'a ulaşma süreleri sırasıyla 6.4, 2.4, 2.3, 1.4, 1.2, dk bulunmuştur.…”

Section: Discussionunclassified

Comparison of Sugammadex and Neostigmine in Short Term Surgery

Koç¹

2015

Ann Clin Anal Med

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ÖzetAmaç: Bu çalışmada kısa süreli elektif cerrahide; rokuronyumla oluşturulan nöromusküler bloğun geri döndürülmesinde sugammadeks ve neostigminin klinik etki ve maliyeti karşılaştırıldı. Gereç ve Yöntem: Yazılı onayları alındık-tan sonra, ASA I-III, öngörülen cerrahi süresi 90 dakikayı aşmayan, 18-65 yaş arası 33 hasta randomize edilerek iki gruba ayrıldı (Grup Sugammadeks, n=16; Grup Neostigmin, n=17). Anestezi indüksiyonunda tüm hastalara fentanil 1-2 µg/kg, tiopental 5-7 mg/kg, rokuronyum 0,6 mg/kg verildi. İdame-de % 50 O2-N2O ve % 1 sevofluran kullanıldı. Nöromusküler blok seviyesi akselomyolografi metoduyla train-o-four (TOF) stimulasyon ile monitorize edildi. Ameliyat sırasında TOF ölçümleri yapılarak TOF 3 olduğunda 0.1-0.2 mg kg ek rokuronyum yapıldı. Cerrahi sonunda TOF 2 olunca Grup S'ye 2 mg/kg sugammadeks yapılırken Grup N'ye 50 µg/kg neostigmin ve 20 µg/ kg atropin uygulandı. Bulgular: Gruplar arasında demografik özellikler benzerdi. TOF oranı 0,9'a ulaşma ve ekstübasyon süreleri Grup S'de ve Grup N'e göre anlamlı olarak kısaydı (2,3±0,9 dk, 9,4±2,7dk ve 6,6±1,6 dk., 12.9±2 dk) (p<0,001). Hasta başına ortalama maliyet Grup S'de, Grup N'e göre anlamlı olarak fazlaydı. (3,13±0,47 TL, 135,36±17,86 TL) (p<0,001). Tartışma: Rokuronyum sonrası nöromusküler fonksiyonların geri dönmesinde TOF oranı 0.9 olması 2 mg/kg sugammadex ile 50 µg/kg neostigmine göre daha hızlı olmakla birlikte sugammadeks neostigminden çok daha pahalıdır. Anahtar KelimelerSugammadeks; Neostigmin; Nöromusküler Blok Abstract Aim: This study compared the efficacy and cost effectivines of sugammadex and neostigmine for reversal of neuromuscular blockade induced by rocuronium for short term elective surgery. Material and Method: After written informed consent, 33 patients aged 18-65, ASA I-III, who were undergoing short term surgery (<90 min) were randomly selected and divided into two groups (Group Sugamadex, n=16; group Neostigmine, n=17). All patients were given 1,5 µg kg-1 fentanyl, 5-7 mgkg-1 thiopental, 0,6 mg kg-1 rocuronium for anaesthesia induction. Anaesthetic maintenance was ensured through 50% O2-N2O and 1% sevoflurane. Neuromuscular blockade was monitored using acceleromyography and a train-of-four (TOF) mode of stimulation. During surgery maintenance doses of 0.1-0.2 mgkg-1 rocuronium were administered according to reappearance of the third response of the TOF. Patients were given sugammadex 2 mg kg_1(group S) or neostigmine 50 µg kg_1 (with atropine 20 µg kg_1) (group N) at reappearance of the second response of the TOF after the last dose of rocuronium in the end of the surgery. Results: Demographic properties were similar in the two groups. Time to recovery of the TOF ratio of 0.9 and extubation time after sugammadex compared with neostigmine were significantly shorter, being 2.3 ± 0.9 versus 9.4 ± 2.7 min and 6.6 ± 1.6 versus 12.9 ± 2 (P<0.001). The costs were higher in group S (71.2 ± 9.8 $ ) than group N (1.7 ± 0.2 $) per patient (p<0.001). Discussion: Recovery of neuromuscular function after rocuronium to a TOF ...

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“…2 mg kg-1 sugammadex is an effective and safe dose accepted in many studies and thus the same dose was used in our study too [9]. Studies carried out have shown that the time elapsing to reach TOF 0.9 shortens, namely the reverse action is accelerated as the dose of sugammadex increases [9]. Similarly, in our study, total cumulative dose of rocuronium was recorded for each patient and no difference was found among the groups in terms of rocuronium doses.…”

Section: Discussionmentioning

confidence: 99%

Reversal effect of sugammadex in isoflurane, sevoflurane, and desflurane induced anesthesia: a randomized-controlled clinical study

Düğer

Şahin²,

İşbir³

et al. 2013

Basic Clin Sci

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Aim. In the present study, we aimed to compare the effects of isoflurane, sevoflurane and desflurane on the effect of sugammadex in reversing neuromuscular block. Methods. Ninty patients who were planned to undergo elective lower abdominal surgery under general anesthesia were included and were randomly assigned to 6 groups of 15. After intubation, group I1 and I2 patients received isoflurane, group S1 and S2 patients received sevoflurane and Group D1 and D2 patients received desflurane volatile anesthetic at 1.25 MAC. TOF values were recorded at the 10th, 20th, 30th, 60th and 90th minutes of the operation by an anesthetist blind to the groups. Group I1, S1 and D1 patients were given 2 mg kg-1 sugammadex and group I2, S2 and D2 patients were given neostigmine after the second response to TOF following the latest rocuronium dose was observed again. In each patient, the time elapsed between sugammadex administrations and 10%, 25% and 90% TOF ratio was recorded. Results. There was no difference among the groups in terms of the time elapsing to reach 10% TOF values while the times elapsing to reach 25% and 90% TOF were found to be the shortest in sevoflurane group and the longest in isoflurane group. Conclusion. We think that inhalation anesthetics used in general anesthetic practice, have different effects on the reversal action of sugammadex in neuromuscular blockade and that reversal effect of sugammadex is faster in patients receiving sevoflurane.

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Org 25969 (sugammadex), a selective relaxant binding agent for antagonism of prolonged rocuronium-induced neuromuscular block

Abstract: Org 25969 effectively reversed a deep and prolonged neuromuscular block induced by rocuronium. The effective reversal dose appears to be 2-4 mg kg(-1).

Cited by 168 publications

References 27 publications

Comparison of Sugammadex and Neostigmine in Terms of Time to Extubation in Pediatrics

Comparison of Sugammadex and Neostigmine in Terms of Time to Extubation in Pediatrics

Comparison of Sugammadex and Neostigmine in Short Term Surgery

Reversal effect of sugammadex in isoflurane, sevoflurane, and desflurane induced anesthesia: a randomized-controlled clinical study

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