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Metodiev Y, Braveman F. Anaesthesia and neurological disorders in pregnancy. BJA Educ 2021; 21:210-217. [PMID: 34026274 DOI: 10.1016/j.bjae.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Y Metodiev
- Cardiff & Vale University Health Board, Cardiff, UK
| | - F Braveman
- University of Minnesota, Minneapolis, MN, USA
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2
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Richardson MG, Raymond BL. Sugammadex Administration in Pregnant Women and in Women of Reproductive Potential. Anesth Analg 2020; 130:1628-1637. [DOI: 10.1213/ane.0000000000004305] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Gurunathan U, Kunju SM, Stanton LML. Use of sugammadex in patients with neuromuscular disorders: a systematic review of case reports. BMC Anesthesiol 2019; 19:213. [PMID: 31744470 PMCID: PMC6862738 DOI: 10.1186/s12871-019-0887-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/05/2019] [Indexed: 12/13/2022] Open
Abstract
Background Sugammadex is a modified gamma-cyclodextrin that acts by selectively encapsulating free amino-steroidal neuromuscular relaxants. Several case reports have been published on the use of sugammadex in patients with neuromuscular disorders that include neuromuscular junction diseases, myopathies, neuropathies, and motor neurone disorders. The primary aim of this review is to systematically review the evidence on the use of sugammadex in patients with this heterogeneous group of diseases and provide recommendations for clinical practice. Methods A systematic electronic search of Medline, Embase and CINAHL databases was done until June 2019, to identify case reports describing the use of sugammadex in adult surgical patients with neuromuscular disorders. Results Of the 578 records identified through database searches, 43 articles were finally included for the systematic review. Of these, 17 reports were on patients with myopathy, 15 reports on myasthenia gravis, 9 reports on motor neuron diseases and 2 reports on neuropathies. Conclusions Majority of the articles reviewed report successful use of sugammadex to reverse steroidal muscle relaxants, especially rocuronium, in patients with neuromuscular diseases. However, with sugammadex, unpredictability in response and uncertainty regarding optimum dose still remain issues. Quantitative neuromuscular monitoring to ensure complete reversal and adequate postoperative monitoring is strongly recommended in these patients, despite the use of sugammadex.
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Affiliation(s)
- Usha Gurunathan
- Department of Anesthesia and Perfusion Services, The Prince Charles Hospital, Rode Road, Chermside, Queensland, 4032, Australia. .,University of Queensland, Brisbane, Australia.
| | - Shakeel Meeran Kunju
- Department of Anesthesia and Perfusion Services, The Prince Charles Hospital, Rode Road, Chermside, Queensland, 4032, Australia.,University of Queensland, Brisbane, Australia
| | - Lisa May Lin Stanton
- Department of Anesthesia and Perfusion Services, The Prince Charles Hospital, Rode Road, Chermside, Queensland, 4032, Australia
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4
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Myotonic Dystrophy and Anesthetic Challenges: A Case Report and Review. Case Rep Anesthesiol 2019; 2019:4282305. [PMID: 31016049 PMCID: PMC6446115 DOI: 10.1155/2019/4282305] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/06/2019] [Accepted: 03/06/2019] [Indexed: 11/21/2022] Open
Abstract
Providing anesthesia to patients with myotonic dystrophy (DM) can be very challenging due to the multisystemic effects of the disease and extreme sensitivity of these patients to sedatives, opioids, and anesthetic agents. Other factors such as hypothermia, shivering, or mechanical or electric stimulation during surgery can precipitate myotonia which is difficult to abolish and can lead to further complications. Generally, local or regional anesthesia is preferred to avoid the complications associated with general anesthesia in this group. However there are several case reports of successful use of general anesthesia (with or without volatile agents and with or without opioids). These general anesthetic cases led to postoperative admission to the regular floor or ICU. We present a case of a woman with a history of DM who underwent robotic assisted laparoscopic hysterectomy under general anesthesia and was discharged home on the same day.
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Abstract
Myotonic disorders represent significant risk in pregnancy due to their complexity and the risk of maternal and fetal complications. Care of these pregnancies requires detailed pre-conception counselling, close monitoring of mother and fetus during the pregnancy and a delivery and postpartum plan involving a multidisciplinary team approach. A case of a woman with myotonia congenita diagnosed in pregnancy is presented, the general principles of care of women with myotonic disorders discussed, and care of the specific conditions in pregnancy reviewed. Trial registration: Not applicable.
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Affiliation(s)
- Adam Morton
- Mater Health, University of Queensland, South Brisbane, Australia
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7
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Creaney M, Moriarty RM, Milner M, Murphy C. Dexmedetomidine, high-flow nasal oxygen and sugammadex-reversal of rocuronium: overcoming anaesthetic challenges in a parturient with congenital muscular dystrophy presenting for caesarean section. Int J Obstet Anesth 2018; 34:108-112. [DOI: 10.1016/j.ijoa.2018.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 01/30/2018] [Accepted: 02/06/2018] [Indexed: 10/18/2022]
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8
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Ahmed S, Naguib A, Tumin D, Tobias JD. Use of Sugammadex in a Patient With Myotonic Dystrophy. Cardiol Res 2018; 9:50-52. [PMID: 29479387 PMCID: PMC5819630 DOI: 10.14740/cr650w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 12/12/2017] [Indexed: 11/11/2022] Open
Abstract
One of the challenges during the perioperative care of patients with myotonic dystrophy is the reversal of neuromuscular blocking agents. Agents that inhibit acetylcholinesterase, such as neostigmine, may precipitate myotonia, and are therefore relatively contraindicated. Sugammadex is a novel pharmacologic agent, which encapsulates rocuronium or vecuronium, thereby reversing their effect. We report anecdotal experience with the use of sugammadex to reverse neuromuscular blockade in a patient with myotonic dystrophy. Concerns with the reversal of neuromuscular blockade in patients with myotonic dystrophy are presented, previous reports of the use of sugammadex in similar clinical scenarios are reviewed, and its advantages are discussed.
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Affiliation(s)
- Samira Ahmed
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Aymen Naguib
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Dmitry Tumin
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Joseph D Tobias
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
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9
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Anaesthesia and orphan disease: rocuronium and sugammadex in the anaesthetic management of a parturient with Becker's myotonia congenita. Eur J Anaesthesiol 2018; 33:545-7. [PMID: 26950083 DOI: 10.1097/eja.0000000000000442] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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10
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Schaller SJ, Lewald H. Clinical pharmacology and efficacy of sugammadex in the reversal of neuromuscular blockade. Expert Opin Drug Metab Toxicol 2016; 12:1097-108. [DOI: 10.1080/17425255.2016.1215426] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Stefan Josef Schaller
- Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Heidrun Lewald
- Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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11
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Stourac P, Adamus M, Seidlova D, Pavlik T, Janku P, Krikava I, Mrozek Z, Prochazka M, Klucka J, Stoudek R, Bartikova I, Kosinova M, Harazim H, Robotkova H, Hejduk K, Hodicka Z, Kirchnerova M, Francakova J, Obare Pyszkova L, Hlozkova J, Sevcik P. Low-Dose or High-Dose Rocuronium Reversed with Neostigmine or Sugammadex for Cesarean Delivery Anesthesia. Anesth Analg 2016; 122:1536-45. [DOI: 10.1213/ane.0000000000001197] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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12
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Ledowski T. Sugammadex: What do we Know and What do we Still Need to Know? A Review of the Recent (2013 to 2014) Literature. Anaesth Intensive Care 2015; 43:14-22. [DOI: 10.1177/0310057x1504300104] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
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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Affiliation(s)
- T. Ledowski
- School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia
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13
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Hélaine L, Le Cocq C, Saadi H, Abdelkrim N, Atti A. [Rocuronium and sugammadex use for the management of neuromuscular blockade in urgent abdominal surgery in a patient with Landouzy-Dejerine myopathy]. ACTA ACUST UNITED AC 2014; 33:587-9. [PMID: 25307303 DOI: 10.1016/j.annfar.2014.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 08/18/2014] [Indexed: 11/15/2022]
Abstract
In patients with neuromuscular diseases, the use of rocuronium in the general anesthesia rapid sequence induction provides safety intubation conditions, but induces a deep and prolonged neuromuscular blockade. We report dose reduction to 0.8mg/kg for a 47-year-old female with Landouzy-Dejerine myopathy. Therefore, less dose of sugammadex was given to reverse the neuromuscular block.
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Affiliation(s)
- L Hélaine
- Service d'anesthésie, centre hospitalier des Pays-de-Morlaix, 15, rue Kersaint-Gilly, BP 97237, 29672 Morlaix cedex, France.
| | - C Le Cocq
- Service d'anesthésie-réanimation, CHU La Cavale-Blanche, boulevard Tanguy-Prigent, 29609 Brest cedex, France
| | - H Saadi
- Service d'anesthésie, centre hospitalier des Pays-de-Morlaix, 15, rue Kersaint-Gilly, BP 97237, 29672 Morlaix cedex, France
| | - N Abdelkrim
- Service d'anesthésie, centre hospitalier des Pays-de-Morlaix, 15, rue Kersaint-Gilly, BP 97237, 29672 Morlaix cedex, France
| | - A Atti
- Service d'anesthésie, centre hospitalier des Pays-de-Morlaix, 15, rue Kersaint-Gilly, BP 97237, 29672 Morlaix cedex, France
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Hopkins AN, Alshaeri T, Akst SA, Berger JS. Neurologic disease with pregnancy and considerations for the obstetric anesthesiologist. Semin Perinatol 2014; 38:359-69. [PMID: 25176638 DOI: 10.1053/j.semperi.2014.07.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Women with neurologic conditions present a challenge during pregnancy and in the peripartum period. Given the low prevalence of these diseases during pregnancy, most management decisions are guided by retrospective reviews and case reports. This article reviews current literature for some of the more common or complex neurologic conditions affecting pregnancy with special consideration for anesthetic management. In particular, epilepsy; multiple sclerosis; primary intracranial hypertension; secondary intracranial hypertension-Arnold-Chiari malformations and intracranial neoplasms; spinal cord injury; neuromuscular junction disorders-myasthenia gravis; and hereditary neuromuscular disorders-myotonic dystrophy and spinal muscular atrophy will be discussed. By increasing understanding of anesthetic issues for parturients with neurologic disease, providers may more effectively anticipate anesthetic considerations, thereby optimizing care plans.
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Affiliation(s)
- Amanda N Hopkins
- Department of Anesthesiology & Critical Care Medicine, The George Washington University School of Medicine & Health Sciences, Washington, DC
| | | | - Seth A Akst
- Department of Anesthesiology & Critical Care Medicine, The George Washington University School of Medicine & Health Sciences, Washington, DC
| | - Jeffrey S Berger
- Department of Anesthesiology & Critical Care Medicine, The George Washington University School of Medicine & Health Sciences, Washington, DC.
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Lobaz S, Clymer M, Sammut M. Safety and Efficacy of Sugammadex for Neuromuscular Blockade Reversal. ACTA ACUST UNITED AC 2014. [DOI: 10.4137/cmt.s10241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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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Affiliation(s)
- Steven Lobaz
- Department of Anaesthetics and Intensive Care Medicine, Northern General Hospital, Sheffield, South Yorkshire, UK
| | - Mark Clymer
- Department of Anaesthetics and Intensive Care Medicine, Northern General Hospital, Sheffield, South Yorkshire, UK
| | - Mario Sammut
- Department of Anaesthetics and Intensive Care Medicine, Freeman Hospital, Newcastle upon Tyne, Tyne and Wear, UK
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