Rocuronium reversed by sugammadex versus mivacurium during high-risk eye surgery: An institutional anaesthetic practice evaluation

Quillfeldt, Susanne von; Föhre, Bettina; Andrees, Nicolai; Spies, Claudia; Galvagni, Daniele; Joussen, Antonia M.; Wernecke, Klaus D.; Boemke, Willehad

doi:10.1177/0300060513489476

Cited by 7 publications

(8 citation statements)

References 38 publications

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“…Deeper levels of NMB resulted in more advantageous reversal times for sugammadex 14 . The incidence of postoperative RNMB with TOF ratios <0.9 or <0.7 was significantly lower in sugammadex-versus neostigmine-or non-reversed (timing) patients 14,16,17 . A significant correlation between RNMB and postoperative chest X-ray pathology was reported in one investigation 16 .…”

Section: Methodsmentioning

confidence: 85%

“…A further study investigating the rate of RNMB at the end of surgery was reported by Von Quillfeldt et al 17 , who describe a smaller observational comparison between 17 patients with a rocuronium/sugammadex combination versus 22 subjects with mivacurium/no reversal. Though surgeons (eye surgery) were 100% satisfied with the operating conditions in both groups, RNMB was frequently observed in the "no reversal", but not the sugammadex group.…”

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confidence: 99%

“…However, it appears that anaesthetists in this study elected to extubate even when the effect of mivacurium hadn't worn off completely (times from end of surgery to extubation were not different between groups). Hence, though the authors describe reversal with sugammadex as an "additional safety dimension" 17 , simply waiting longer until extubation in the mivacurium group might have prevented RNMB as well within a (hypothetically) reasonable time frame. This study may thus be best suited to underline the importance of neuromuscular monitoring.…”

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confidence: 99%

See 2 more Smart Citations

Sugammadex: What do we Know and What do we Still Need to Know? A Review of the Recent (2013 to 2014) Literature

Ledowski

2015

Anaesth Intensive Care

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Since its launch in 2008, sugammadex has been considered one of the most significant developments in anaesthesia-related pharmacology. With almost 500 sugammadex-related publications and over nine million patient exposures worldwide, user experience and scientific data have grown exponentially. However, several important questions are yet to be answered. This article reviews the sugammadex-related literature in 2013 and 2014 to determine which of these questions have been answered more fully over the last 18 months and which questions require more information and research.

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Section: Methodsmentioning

confidence: 85%

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confidence: 99%

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confidence: 99%

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Sugammadex: What do we Know and What do we Still Need to Know? A Review of the Recent (2013 to 2014) Literature

Ledowski

2015

Anaesth Intensive Care

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“…Many previous studies demonstrated that sugammadex reverses NMB 3 to 8 times faster than conventional reversal agent does. [ 19 , 20 ] In addition, sugammadex could reduce the incidence of residual NMB, [ 21 ] thus may result in reduced early postoperative pulmonary complications. [ 7 , 22 ] Postoperative residual muscle relaxation is associated with an increased risk of morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

Comparison of postoperative coagulation profiles and outcome for sugammadex versus pyridostigmine in 992 living donors after living-donor hepatectomy

Moon

Kim

et al. 2018

Medicine

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Donor safety is the major concern in living donor liver transplantation, although hepatic resection may be associated with postoperative coagulopathy. Recently, the use of sugammadex has been gradually increased, but sugammadex is known to prolong prothrombin time (PT) and activated partial thromboplastin time (aPTT). We compared the postoperative coagulation profiles and outcomes of sugammadex versus pyridostigmine group in donors receiving living donor hepatectomy.Consecutive donor hepatectomy performed between September 2013 and August 2016 was retrospectively analyzed. For reversal of rocuronium-induced neuromuscular blockade, donors received sugammadex 4 mg/kg or pyridostigmine 0.25 mg/kg. The primary end-points were laboratory findings (PT, aPTT, hemoglobin, platelet count) and clinically evaluated postoperative bleeding (relaparotomy for bleeding, cumulative volume collected in drains). Secondary outcomes were anesthesia time, postoperative hospital day.Of 992 donors, 383 treated with sugammadex and 609 treated with pyridostigmine for the reversal of neuromuscular blockade. There were no significant differences between both groups for drop in hemoglobin and platelet, prolongation in PT, aPTT, and the amount of 24-h drain volume. Bleeding events within 24 h were reported in 2 (0.3%) for pyridostigmine group and 0 (0%) for sugammadex group (P = .262). Anesthesia time was significantly longer in pyridostigmine group than that in sugammadex group (438.8 ± 71.4 vs. 421.3 ± 62.3, P < .001). Postoperative hospital stay was significantly longer in pyridostigmine group than that in sugammadex group (P = .002).Sugammadex 4 mg/kg was not associated with increased bleeding tendency, but associated with reduced anesthesia time and hospital stay. Therefore, sugammadex may be safely used and will decrease morbidity in donor undergoing living-donor hepatectomy.

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“…123 Sugammadex use enables rapid reversal of deep neuromuscular block to be feasible, and it is this property that is being utilized in many surgical situations, particularly in day case and fast-track procedures, and bariatric, ophthalmic, laparoscopic general, and intra-operative spinal surgery. 124–127 There is an indication for sugammadex use to reverse rapidly profound rocuronium blockade post-Caesarean section. 80…”

Section: Clinical Studies (Post-marketing) and Sugammadex Indicationsmentioning

confidence: 99%

Safety and Efficacy of Sugammadex for Neuromuscular Blockade Reversal

Lobaz

Clymer

Sammut

2014

Clinical Medicine Insights: Therapeutics

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AbstrAct:Since its first human use in 2005, the γ-cyclodextrin sugammadex (Org 25969) has had the potential to become the reversal agent of choice, for rocuronium-or vecuronium-induced neuromuscular blockade. Sugammadex binds to the aminosteroid neuromuscular blocker, encapsulating it and extracting it from the neuromuscular junction, effectively ceasing activity and allowing neuromuscular transmission to recover rapidly. Phases I-III and subsequent trials have found sugammadex to be safe and effective in a wide range of doses and for the reversal of a range of depth of muscle relaxation in healthy volunteers and a variety of disease states. Sugammadex use may allow refinement of anesthetic practice and improvement in surgical conditions, through the maintenance of deep neuromuscular blockade right to the end of surgery, with subsequent rapid reversal. Debate remains about the use of sugammadex in the treatment of rocuronium anaphylaxis and airway emergencies. The high price of sugammadex currently prohibits its routine use, but if the price falls, after expiry of its patent, it may become cost-effective as a readily available agent in certain specific clinical situations. Serious adverse reactions have occurred in less than 1% of patients and are most commonly because of hypersensitivity. No deaths have been reported, but caution is advised in neonates, pediatrics, and pregnancy where data are lacking.

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Rocuronium reversed by sugammadex versus mivacurium during high-risk eye surgery: An institutional anaesthetic practice evaluation

Cited by 7 publications

References 38 publications

Sugammadex: What do we Know and What do we Still Need to Know? A Review of the Recent (2013 to 2014) Literature

Sugammadex: What do we Know and What do we Still Need to Know? A Review of the Recent (2013 to 2014) Literature

Comparison of postoperative coagulation profiles and outcome for sugammadex versus pyridostigmine in 992 living donors after living-donor hepatectomy

Safety and Efficacy of Sugammadex for Neuromuscular Blockade Reversal

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