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Vanacker BF, Vermeyen KM, Struys MM, Rietbergen H, Vandermeersch E, Saldien V, Kalmar AF, Prins ME: Reversal of rocuronium-induced neuromuscular block with the novel drug sugammadex is equally effective under maintenance anesthesia with propofol or sevoflurane

University of Antwerp, Antwerpen, Flemish, Belgium
Anesthesia and analgesia (Impact Factor: 3.42). 04/2007; 104(3):563-8. DOI: 10.1213/01.ane.0000231829.29177.8e
Source: PubMed

ABSTRACT In this study we investigated whether the novel reversal drug, sugammadex, is equally effective at reversing rocuronium-induced neuromuscular block (NMB) in patients under propofol or sevoflurane maintenance anesthesia. After receiving propofol for induction, patients were randomized to propofol (n = 21) or sevoflurane (n = 21). Rocuronium 0.6 mg/kg was administered for tracheal intubation. NMB was monitored using acceleromyography. At reappearance of the second twitch of the train-of-four ratio, sugammadex 2.0 mg/kg was administered by IV bolus. The primary end-point was time from start of sugammadex administration to recovery of train-of-four ratio to 0.9. Mean recovery time was 1.8 min after both propofol and sevoflurane anesthesia. The 95% confidence interval for the difference in recovery time between the 2 groups (-0.5 to +0.4 min) was well within the predefined equivalence interval (-1 to +1 min), indicating that recovery from NMB was unaffected by maintenance anesthesia. Thirteen patients (propofol n = 4; sevoflurane n = 9) experienced adverse events; these were treatment-related in 4 patients (propofol n = 3; sevoflurane n = 1). There were no treatment-related serious adverse events and no discontinuations or deaths. No residual paralysis occurred. The safety profile of sugammadex was somewhat more favorable under propofol than under sevoflurane anesthesia.

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    • "Clinical studies of sugammadex in surgical patients have shown that sugammadex provides effective, dose-dependent reversal of both moderate and deep/intense rocuronium-induced neuromuscular blockade during propofol maintenance anesthesia. Sevoflurane is widely used in clinical practice and enhances neuromuscular blockade, the safety and efficacy of various doses of sugammadex under maintenance anesthesia with volatile drugs remain largely unknown especially after administration at deep neuromuscular blockade [15] [16] [17]. "
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    ABSTRACT: The current prospective comparative study aimed at the clinical outcome of sugammadex reversal of neuromuscular blockade (NMB) and the evaluation of its impact on the frequency of critical respiratory events during sevoflurane anesthesia. Patients and methods The study included 100 male patients with mean age of 33.1 ± 7.5 years; 67 patients of ASA grade I, 27 patients of ASA grade II and 6 patients of ASA grade III. Patients were randomly allocated to two equal groups: Group N received reversal of NMB using intravenous (IV) neostigmine (6 μg/kg) and Group S received IV sugammadex (2 mg/kg). After induction of anesthesia, NM function was monitored, at the wrist; using the TOF-Watch-SX. At the end of the surgery, the reversal of NMB assigned for each group was administered at least after 15 min after the last dose of atracurium and NM monitoring was continued until recovery of the TOF T4/T1 ratio to 0.9. Time since injection of the reversal drug till recovery to TOF ratio of 0.9 was recorded and critical respiratory events (CRE) were monitored. Results Both groups showed non-significant difference as regards the frequency of patients required top doses of NMBD or the mean number of top doses of NMBD. Time till achievement of TOF ratio of 0.9 was significantly shorter with sugammadex compared to neostigmine. Moreover, mean time to achieve TOF ratio of 0.9 was 2.76 ± 1.5 min with sugammadex, but was 9.78 ± 2 min with neostigmine with significant difference in favor of sugammadex. CRE were recorded in 5 patients (5%); 3 patients with neostigmine (6%) and 2 patients (4%) with sugammadex. Conclusion NMB reversal using sugammadex allowed significantly earlier achievement of TOF ratio of 0.9 in significantly higher number of patients with minimally and acceptable respiratory events at PACU in comparison with neostigmine.
    01/2013; 30(1). DOI:10.1016/j.egja.2013.09.007
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    nicholson.wayne@mayo.edu · Juraj Sprung · Christopher J Jankowski
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    ABSTRACT: Incomplete recovery following reversal of neuromuscular blockade can present as a clinical problem in surgical patients. Emerging pharmacologic solutions may prevent such adverse outcomes in the future. We briefly review two methods of pharmacologic reversal of neuromuscular blockade. Both methods of reversal are effective. However the early studies of the new compound, sugammadex has been shown to achieve a more rapid, stable reversal of steroidal based neuromuscular blocking agents compared to neostigmine. Due to the novel mechanism of action of this agent, sugammadex has been demonstrated to be effective even when administered during profound neuromuscular block, without evidence of recurarization.
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    ABSTRACT: Hintergrund Die bronchopulmonale Aspiration ist eine weit gefürchtete Komplikation in der Anästhesie. Ihre Inzidenz wird mit etwa 0,3–1% angegeben, und sie geht mit deutlich erhöhter Morbidität sowie Mortalität einher (Beck-Schimmer u. Bonvini, Eur J Anaesthesiol 2011, 28:78–84). Die „rapid sequence induction“ (RSI, Notfalleinleitung) stellt das Verfahren der Wahl zur Narkoseeinleitung des aspirationsgefährdeten Patienten dar. Seit mittlerweile über 50 Jahren gilt bei der RSI Succinylcholin aufgrund seiner kurzen Anschlagszeit und kurzer Wirkdauer als Relaxans der Wahl. Im Hinblick auf das ausgeprägte Nebenwirkungsprofil von Succinylcholin wurde versucht, besser geeignete, alternative Relaxanzien, wie beispielsweise Rocuronium zur RSI einzusetzen. Material und Methode In einer kleinen Fallserie wurde im Rahmen von Sectiones im Kreißsaal bei 10 Schwangeren ein modifiziertes RSI-Protokoll verwendet. Dieses beinhaltete zur Einleitung der Muskelrelaxation die Gabe von 1,0 mg/kgKG Rocuronium und die Aufrechterhaltung einer tiefen Relaxierung bis zum Ende der Operation. Zur Reversierung der neuromuskulären Blockade nach Beendigung der Hautnaht wurde das µ-Zyklodextrin Sugammadex, in einer Dosierung abhängig von der Tiefe der neuromuskulären Restblockade, appliziert. Neben den Intubationsbedingungen nach 60 s wurden Nebenwirkungen wie Herzrhythmusstörungen, Heiserkeit, anaphylaktische Reaktionen, postoperative Übelkeit und Erbrechen postoperativ, nach 24 und 48 h erfragt sowie dokumentiert. Schlussfolgerungen Die Kombination von Rocuronium und Sugammadex zur RSI im Rahmen von Sectiones im Kreißsaal vereint neben den Vorteilen der nichtdepolarisierenden Eigenschaften des Rocuroniums schnelle Anschlagszeiten, sehr gute Intubationsbedingungen und die rasche Reversierung durch Sugammadex am Operationsende. Schwerwiegende Nebenwirkungen wurden nicht beobachtet. Heiserkeit sowie Halsschmerzen beklagten 30% und Muskelschmerzen 10% der untersuchten Frauen bis 48 h nach dem Eingriff.
    Der Anaesthesist 08/2012; 61(8). DOI:10.1007/s00101-012-2065-6 · 0.74 Impact Factor
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