Sugammadex as a reversal agent for neuromuscular block: an evidence-based review

Schaller, Stefan J.; Fink, Heidrun

doi:10.2147/ce.s35675

Cited by 46 publications

(44 citation statements)

References 105 publications

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“…Sugammadex has been specifically designed to antagonize rocuronium-induced neuromuscular blockade [11,12,13]. Its chemical structure is a modified γ-cyclodextrin with 8 sugar molecules forming a rigid ring with a central lipophilic cavity designed to incorporate the rocuronium molecule.…”

Section: Introductionmentioning

confidence: 99%

Non-IgE-Dependent Hypersensitivity to Rocuronium Reversed by Sugammadex: Report of Three Cases and Hypothesis on the Underlying Mechanism

Spoerl

D''Incau

Roux‐Lombard

et al. 2016

Int Arch Allergy Immunol

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We present 3 cases of pseudoallergic (anaphylactoid) reactions to perioperatively administered rocuronium, which rapidly resolved after sugammadex injection. Allergological workup showed no evidence for immediate-type hypersensitivity to the drugs used for anesthesia, including rocuronium. However, rocuronium induced an irritative reaction in skin tests in all 3 patients and in 3 healthy individuals. This reaction was specifically suppressed by adding sugammadex at a 1:1 molecular proportion to rocuronium before the skin tests. This observation suggests that the patients suffered from a pseudoallergic reaction, and indicates that sugammadex might act via the inhibition of non-IgE mediated MRGPRX2 (Mas-related G-protein-coupled receptor member X2)-triggered mast cell degranulation induced by rocuronium.

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Section: Introductionmentioning

confidence: 99%

Non-IgE-Dependent Hypersensitivity to Rocuronium Reversed by Sugammadex: Report of Three Cases and Hypothesis on the Underlying Mechanism

Spoerl

D''Incau

Roux‐Lombard

et al. 2016

Int Arch Allergy Immunol

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“…Preoperative coagulation tests (platelet count, PT and aPTT) were normal in our study population. Sugammadex has an elimination half-life of 100–150 minutes so blood samples were taken 120 minutes after administration of sugammadex for PT and aPTT measurements in all patients [ 14 ]. We did not investigate the postoperative platelet count since sugammadex has no reported effect on platelet count and aggregation [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of Sugammadex on Postoperative Bleeding and Coagulation Parameters After Septoplasty: A Randomized Prospective Study

et al. 2015

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BackroundSugammadex is a reversal agent with well known advantages but it’s effects on haemostasis and bleeding have been a topic of interest. Septoplasty is a common surgical procedure with postoperative respiratory complications and bleeding. The aim of this study is to investigate the effects of sugammadex on postoperative coagulation parameters and bleeding after septoplasty procedure.Material/MethodsIn this randomized controlled study, fifty patients were grouped into two groups; neostigmine (Group N) vs. sugammadex (Group S). For the evaluation of PT, aPTT and INR, blood samples were taken for at the postoperative 120th minutes and alteration of these values with respect to preoperative values were documented. Postoperative bleeding was measured by evaluating the amount of blood absorbed on the nasal tip dressing during 3 hours postoperatively.ResultsPostoperative bleeding amount was significantly higher in the Group S compared to Group N (p=0.013). No significant difference was observed between two groups according to coagulation parameters (PT; p=0.953, aPTT; p=0.734, INR; p=0.612).ConclusionsSugammadex was associated with higher amount of postoperative bleeding than neostigmine in septoplasty patients. In surgical procedures having high risk of bleeding the safety of sugammadex need to be verified.

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“…This restores neuromuscular transmission and muscle strength. The inactive complex of rocuronium and sugammadex is excreted by the kidneys [23].…”

Section: Failed Intubation and Reversal Of The Neuromuscular Block Prmentioning

confidence: 99%

RSII rapid-sequence induction of anaesthesia and intubation of the trachea

Wołoszczuk-Gębicka

2017

Disaster Emerg Med J

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Rapid sequence induction and intubation (RSII) is the preferred method of tracheal intubation in emergency situations for patients presenting with a full stomach. The aim of RSII is to intubate the trachea within 60 seconds, without having to use bag-valve-mask ventilation to avoid air insufflation into the stomach. After preoxygenation and while cricoid pressure is applied, an induction dose of intravenous anaesthetic agent is administered and rapidly followed by a fast-acting muscle relaxant, and after 60 seconds tracheal intubation is performed. Preoxygention increases apnoea tolerance. This is particularly important for infants and young children, and in patients who are in critical condition, obese or pregnant. Cricoid pressure (the Sellick manouver) is recommended to prevent regurgitation of the gastric contents to the throat. Propofol or thiopental are routinely used for induction. Ketamine or etomidate may be used if propofol or thiopental administration is contraindicated. Succinylcholine or rocuronium are used to facilitate tracheal intubation. Poor jaw relaxation, patient resistance to a laryngoscope, closed or closing vocal cords, vigorous limb movements or sustained coughing after tube insertion are not clinically acceptable. Modified rapid sequence induction, used in patients at risk of rapid development of hypoxaemia, allows gentle positive pressure ventilation after administration of the induction agent and muscle relaxant, but before the tracheal intubation. If the attempt of intubation fails, sugammadex, 16 mg/kg body weight is recommended for the immediate reversal of the neuromuscular block produced by rocuronium, but not for other muscle relaxants.

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Sugammadex as a reversal agent for neuromuscular block: an evidence-based review

Cited by 46 publications

References 105 publications

Non-IgE-Dependent Hypersensitivity to Rocuronium Reversed by Sugammadex: Report of Three Cases and Hypothesis on the Underlying Mechanism

Non-IgE-Dependent Hypersensitivity to Rocuronium Reversed by Sugammadex: Report of Three Cases and Hypothesis on the Underlying Mechanism

Effect of Sugammadex on Postoperative Bleeding and Coagulation Parameters After Septoplasty: A Randomized Prospective Study

RSII rapid-sequence induction of anaesthesia and intubation of the trachea

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