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Ongun MC, Oc B, Oc M, Bariskaner H. The effects of sugammadex on isolated human internal mammary artery and saphenous vein rings. Korean J Anesthesiol 2024; 77:484-485. [PMID: 38772569 PMCID: PMC11294872 DOI: 10.4097/kja.24017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 05/23/2024] Open
Affiliation(s)
- Mert C. Ongun
- Department of Medical Pharmacology, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Bahar Oc
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Mehmet Oc
- Department of Cardiovascular Surgery, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Hulagu Bariskaner
- Department of Medical Pharmacology, Faculty of Medicine, Selcuk University, Konya, Turkey
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Weerasuriya S, Seddon D, Salota V. Asystolic cardiac arrest secondary to sugammadex administration in a young patient. Anaesthesiol Intensive Ther 2024; 56:160-163. [PMID: 39166508 PMCID: PMC11284579 DOI: 10.5114/ait.2024.141235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/09/2024] [Indexed: 08/23/2024] Open
Affiliation(s)
- Scott Weerasuriya
- Department of Anaesthesia, Queen Elizabeth Hospital, Lewisham & Greenwich NHS Trust, United Kingdom
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Boo KY, Park SH, Park SK, Na C, Kim HJ. Cardiac arrest due to coronary vasospasm after sugammadex administration -a case report. Korean J Anesthesiol 2023; 76:72-76. [PMID: 35978452 PMCID: PMC9902188 DOI: 10.4097/kja.22335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/16/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Sugammadex is a widely used medication for the reversal of aminosteroid neuromuscular blockades. Although sugammadex is generally regarded to be safe, concerns about the risk of serious complications have emerged. CASE A 57-year-old man without a history of coronary disease was scheduled for general anesthesia to undergo cardiac radiofrequency catheter ablation due to symptomatic persistent atrial fibrillation and flutter. At the end of the procedure, he was given 400 mg of sugammadex. A little later, the electrocardiogram showed a sudden ST elevation on the inferior leads, followed by cardiac arrest. The urgent coronary angiography demonstrated total collapse of the right coronary artery. After two injections of intra-coronary nitroglycerin, the vasospasm of the right coronary artery was completely resolved. The patient recovered without sequelae and was discharged on postoperative day 5. CONCLUSIONS Clinicians should pay close attention to the potential risk of coronary vasospasm, even cardiac arrest, after sugammadex administration.
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Affiliation(s)
- Ki Yung Boo
- Department of Cardiology, Jeju National University Hospital, Jeju, Korea
| | - Sang Hyun Park
- Department of Anesthesiology and Pain Medicine, Jeju National University College of Medicine, Jeju, Korea
| | - Sun Kyung Park
- Department of Anesthesiology and Pain Medicine, Jeju National University College of Medicine, Jeju, Korea
| | - Changrock Na
- Department of Anesthesiology and Pain Medicine, Jeju National University Hospital, Jeju, Korea
| | - Hyun Jung Kim
- Department of Anesthesiology and Pain Medicine, Jeju National University College of Medicine, Jeju, Korea,Corresponding author: Hyun Jung Kim, M.D., Ph.D. Department of Anesthesiology and Pain Medicine, Jeju National University College of Medicine, 15 aran 13-gil, Jeju 63241, KoreaTel: +82-64-717-2026Fax: +82-64-717-1131
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Greco M, Caruso PF, Angelotti G, Aceto R, Coppalini G, Martinetti N, Albini M, Bash LD, Carvello M, Piccioni F, Monzani R, Montorsi M, Cecconi M. REVersal of nEuromusculAr bLocking Agents in Patients Undergoing General Anaesthesia (REVEAL Study). J Clin Med 2023; 12:jcm12020563. [PMID: 36675492 PMCID: PMC9866312 DOI: 10.3390/jcm12020563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/03/2023] [Accepted: 01/06/2023] [Indexed: 01/13/2023] Open
Abstract
Background: Neuromuscular blocking agent (NMBA) monitoring and reversals are key to avoiding residual curarization and improving patient outcomes. Sugammadex is a NMBA reversal with favorable pharmacological properties. There is a lack of real-world data detailing how the diffusion of sugammadex affects anesthetic monitoring and practice. Methods: We conducted an electronic health record analysis study, including all adult surgical patients undergoing general anesthesia with orotracheal intubation, from January 2016 to December 2019, to describe changes and temporal trends of NMBAs and NMBA reversals administration. Results: From an initial population of 115,046 surgeries, we included 37,882 procedures, with 24,583 (64.9%) treated with spontaneous recovery from neuromuscular block and 13,299 (35.1%) with NMBA reversals. NMBA reversals use doubled over 4 years from 25.5% to 42.5%, mainly driven by sugammadex use, which increased from 17.8% to 38.3%. Rocuronium increased from 58.6% (2016) to 94.5% (2019). Factors associated with NMBA reversal use in the multivariable analysis were severe obesity (OR 3.33 for class II and OR 11.4 for class III obesity, p-value < 0.001), and high ASA score (OR 1.47 for ASA III). Among comorbidities, OSAS, asthma, and other respiratory diseases showed the strongest association with NMBA reversal administration. Conclusions: Unrestricted availability of sugammadex led to a considerable increase in pharmacological NMBA reversal, with rocuronium use also rising. More research is needed to determine how unrestricted and safer NMBA reversal affects anesthesia intraoperative monitoring and practice.
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Affiliation(s)
- Massimiliano Greco
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
- Department of Anaesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
- Correspondence:
| | - Pier Francesco Caruso
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
| | | | - Romina Aceto
- Department of Anaesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
| | - Giacomo Coppalini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
- Department of Anaesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
| | - Nicolò Martinetti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
- Department of Anaesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
| | - Marco Albini
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy
| | | | - Michele Carvello
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
- Department of Surgery, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
| | - Federico Piccioni
- Department of Anaesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
| | - Roberta Monzani
- Department of Anaesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
| | - Marco Montorsi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
- Department of Surgery, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
- Department of Anaesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
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Hyland SJ, Pandya PA, Mei CJ, Yehsakul DC. Sugammadex to Facilitate Neurologic Assessment in Severely Brain-Injured Patients: Retrospective Analysis and Practical Guidance. Cureus 2022; 14:e30466. [DOI: 10.7759/cureus.30466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2022] [Indexed: 11/07/2022] Open
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Yang JL, Chen KB, Shen ML, Hsu WT, Lai YW, Hsu CM. Sugammadex for reversing neuromuscular blockages after lung surgery: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e30876. [PMID: 36181093 PMCID: PMC9524927 DOI: 10.1097/md.0000000000030876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND This study determined whether sugammadex was associated with a lower risk of postoperative pulmonary complications and improved outcomes in lung surgeries. METHODS A systematic literature search was conducted using PubMed, Embase, Web of Science, and the Cochrane Library from January 2000 to March 2022. The characteristics of lung surgeries using sugammadex treatment compared with control drugs and postoperative outcomes were retrieved. The primary outcome was estimated through a pooled odds ratio (OR) and its 95% confidence interval (CI) was identified using a random-effects model. RESULTS From 465 citations, 7 studies with 453 patients receiving sugammadex and 452 patients receiving a control were included. The risk of postoperative pulmonary complication (PPCs) was lower in the sugammadex group than in the control group. Also, it showed that the effect of sugammadex on PPCs in the subgroup analysis was significantly assessed on the basis of atelectasis or non-atelectasis. Furthermore, subgroup analysis based on the relationship between high body mass index (BMI) and PPCs also showed that sugammadex had less occurrence in both the high BMI (defined as BMI ≥ 25) and low BMI groups. No difference in length of hospital stay (LOS) between the two groups was observed. CONCLUSION This study observed that although reversing neuromuscular blockages with sugammadex in patients undergoing thoracic surgery recorded fewer PPCs and shorter extubation periods than conventional reversal agents, no difference in LOS, postanaesthesia care unit (PACU) stay length and chest tube insertion duration in both groups was observed.
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Affiliation(s)
- Jia-Li Yang
- Department of Anesthesiology, China Medical University Hospital, Taichung, Taiwan
| | - Kuen-Bao Chen
- Department of Anesthesiology, China Medical University Hospital, Taichung, Taiwan
- Department of Anesthesiology, College of Medicine, China Medical University, Taichung, Taiwan
| | - Mei-Ling Shen
- Department of Anesthesiology, Taichung Tzu-Chi Hospital, Taichung, Taiwan
| | - Wei-Ti Hsu
- Department of Anesthesiology, China Medical University Hospital, Taichung, Taiwan
| | - Yu-Wen Lai
- Department of Nursing, China Medical University Hospital, Taichung, Taiwan
| | - Chieh-Min Hsu
- Department of Anesthesiology, China Medical University Hospital, Taichung, Taiwan
- *Correspondence: Chieh-Min Hsu, Department of Anesthesiology, China Medical University Hospital, 40447 No.2, Yude Rd., North Dist., Taichung City 40447, Taiwan (e-mail: )
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Yun Y, Cao D, Zhang X, Ouyang W, Min S, Lv J, Li L, Huang F. Glycopyrrolate versus atropine for preventing bradycardia induced by neostigmine injection after general anesthesia surgery: a randomized open, parallel-controlled multicenter clinical trial. Am J Transl Res 2021; 13:12996-13002. [PMID: 34956516 PMCID: PMC8661237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 09/22/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE With atropine as a positive control, randomized controlled clinical trials were conducted to verify the efficacy of glycopyrrolate injection in preventing bradycardia caused by neostigmine. METHOD Patients undergoing elective general anesthesia and non-cardiac surgery were randomly divided into an experimental group (129 cases) and control group (127 cases) (ChiCTR2100046022, http://www.chictr.org.cn/showproj.aspx?proj=126075). At the end of the operation, the test group was given glycopyrrolate 6 ug/kg + neostigmine 0.04 mg/kg, and the control group was given atropine 0.016 mg/kg + neostigmine 0.04 mg/kg, bolus time 1 min, to antagonize muscle residual effects of relaxants. We compared the area under the time curve (AUC) of the difference between heart rate and baseline heart rate within 15 minutes of administration, the measured value of heart rate per minute, and the change in heart rate compared with baseline. We verified the safety of glycopyrrolate injection through laboratory tests, clinical symptoms, signs, and adverse events/serious adverse events. RESULTS The AUC of the experimental group's heart rate within 15 minutes after the administration was lower than the baseline heart rate change value, (P<005). The measured value of the heart rate at each time changed less than the control group; the experimental group's heart rate remained at the baseline level for longer than the control group (P<005). There was no significant difference in the incidence of adverse reactions between the two groups of patients (P>005). CONCLUSION Glycopyrrolate and atropine are safe to prevent heart rate slowing induced by the non-depolarizing muscle relaxant antagonist neostigmine, and glycopyrrolate is more conducive to maintaining a stable heart rate in patients.
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Affiliation(s)
- Yue Yun
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical UniversityBeijing 100000, China
| | - Dianqing Cao
- Department of Anesthesiology, Affiliated Hospital of Guangdong Medical UniversityZhanjiang 524000, Guangdong, China
| | - Xiaoqing Zhang
- Department of Anesthesiology, Shanghai Tongji HospitalShanghai 200000, China
| | - Wen Ouyang
- Department of Anesthesiology, The Third Xiangya Hospital, Central South UniversityChangsha 410000, Hunan, China
| | - Su Min
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical UniversityChongqing 400000, China
| | - Jianrui Lv
- Department of Anesthesiology, The Second Affiliated Hospital of Xi’an Jiaotong UniversityXi’an 710000, Shaanxi, China
| | - Lin Li
- Department of Anesthesiology, General Hospital of Shenyang Military Region of PLAShenyang 110000, Liaoning, China
| | - Furong Huang
- Department of Anesthesiology, The First People’s Hospital of ChangdeChangde 415000, Hunan, China
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