Sugammadex: an opportunity for more thinking or more cookbook medicine?

Donati, François

doi:10.1007/bf03026865

Cited by 21 publications

(21 citation statements)

References 12 publications

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“…13 The second is that too much sugammadex on board would limit the options should reintubation of the trachea or repeat surgery be needed shortly after the end of the case. 15,16 However, the concept of reversal of residual neuromuscular block with clinically limited dose range of sugammadex generated concern about reparalysis, arguing that sugammadex 1.0 mg/kg or 0.5 mg/kg is insufficient to restore the safety margin of the neuromuscular junction; thus, rebound of the block may happen. 17,18 Actually only a few studies have investigated the effect of low-dose sugammadex on the reversal of shallow residual neuromuscular blocks.…”

Section: Summary Of Resultsmentioning

confidence: 99%

Reversal of Vecuronium-induced Neuromuscular Blockade with Low-dose Sugammadex at Train-of-four Count of Four

et al. 2017

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Background Rocuronium-induced neuromuscular block that spontaneously recovered to a train-of-four count of four can be reversed with sugammadex 0.5 or 1.0 mg/kg. We investigated whether these doses of sugammadex can also reverse vecuronium at a similar level of block. Methods Sixty-five patients were randomly assigned, and 64 were analyzed in this controlled, superiority study. Participants received general anesthesia with propofol, sevoflurane, fentanyl, and vecuronium. Measurement of neuromuscular function was performed with acceleromyography (TOF-Watch-SX, Organon Teknika B.V., The Netherlands ). Once the block recovered spontaneously to four twitches in response to train-of-four stimulation, patients were randomly assigned to receive sugammadex 0.5, 1.0, or 2.0 mg/kg; neostigmine 0.05 mg/kg; or placebo. Time from study drug injection to normalized train-of-four ratio 0.9 and the incidence of incomplete reversal within 30 min were the primary outcome variables. Secondary outcome was the incidence of reparalysis (normalized train-of-four ratio less than 0.9). Results Sugammadex, in doses of 1.0 and 2.0 mg/kg, reversed a threshold train-of-four count of four to normalized train-of-four ratio of 0.9 or higher in all patients in 4.4 ± 2.3 min (mean ± SD) and 2.6 ± 1.6 min, respectively. Sugammadex 0.5 mg/kg reversed the block in 6.8 ± 4.1 min in 70% of patients (P < 0.0001 vs. 1.0 and 2.0 mg/kg), whereas neostigmine produced reversal in 11.3 ± 9.7 min in 77% of patients (P > 0.05 vs. sugammadex 0.5 mg/kg). The overall frequency of reparalysis was 18.7%, but this incidence varied from group to group. Conclusions Sugammadex 1.0 mg/kg, unlike 0.5 mg/kg, properly reversed a threshold train-of-four count of four vecuronium-induced block but did not prevent reparalysis.

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Section: Summary Of Resultsmentioning

confidence: 99%

Reversal of Vecuronium-induced Neuromuscular Blockade with Low-dose Sugammadex at Train-of-four Count of Four

et al. 2017

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“…28,29 With traditional reversal using neostigmine, residual blockade is a common occurrence and can lead to adverse outcomes. 30,31 The use of sugammadex as a rescue during residual paralysis prevents negative sequelae associated with prolonged intubation or extubation after incomplete cholinesterase inhibitor reversal.…”

Section: Dosingmentioning

confidence: 99%

Sugammadex: A neuromuscular blockade agent encapsulator

Hurtado

2017

The Chronicles

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“…In allen englischsprachigen Top-Zeitschriften des Fachgebietes Anästhesiologie sind Leitartikel zu Sugammadex erschienen. Mit vielleicht einer Ausnahme [19] kamen sie allesamt zu einer beinahe enthusiastischen Einschätzung dieses neuen Pharmakons; dies kommt auch in der Wahl der Titel -"revolutionary approach" [35], "milestone" [45] und "opportunity to change the practice of anesthesiology" [43] Die primäre bzw. sekundäre Zielgröße der Dosisfindungsstudien war die Zeitdauer von der Gabe des Muskelrelaxans (Rocuronium, Vecuronium oder Pancuronium) bis zur Erholung der TOF-Ratio auf 0,9 bzw.…”

Section: Zulassungunclassified

Sugammadex

2008

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Up to now only acetylcholine esterase inhibitors, such as neostigmine, were available as antagonists of residual neuromuscular blocks. Sugammadex is a modified gamma-cyclodextrin that binds rocuronium and chemically similar aminosteroidal muscle relaxants, such as vecuronium. The underlying mechanism of action is new and differs completely from that of acetylcholine esterase inhibitors. This review summarizes data published so far within the framework of the licensing procedure about the efficacy, safety and side-effects of sugammadex and presents potential new anesthesiological concepts using this compound.

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Sugammadex: an opportunity for more thinking or more cookbook medicine?

Cited by 21 publications

References 12 publications

Reversal of Vecuronium-induced Neuromuscular Blockade with Low-dose Sugammadex at Train-of-four Count of Four

Reversal of Vecuronium-induced Neuromuscular Blockade with Low-dose Sugammadex at Train-of-four Count of Four

Sugammadex: A neuromuscular blockade agent encapsulator

Sugammadex

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