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Motamed C. Sugammadex in Emergency Situations. J Pers Med 2023; 13:jpm13010159. [PMID: 36675820 PMCID: PMC9867288 DOI: 10.3390/jpm13010159] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
Sugammadex may be required or used in multiple emergency situations. Moderate and high doses of this compound can be used inside and outside the operating room setting. In this communication, recent developments in the use of sugammadex for the immediate reversal of rocuronium-induced neuromuscular blockade were assessed. In emergency surgery and other clinical situations necessitating rapid sequence intubation, the tendency to use rocuronium followed by sugammadex instead of succinylcholine has been increasing. In other emergency situations such as anaphylactic shock caused by rocuronium or if intubation or ventilation is not possible, priority should be given to resuming ventilation maintaining hemodynamic stability, in accordance with the traditional guidelines. If necessary for the purpose of resuming ventilation, reversal of neuromuscular blockade should be done in a timely fashion.
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Affiliation(s)
- Cyrus Motamed
- Departement of Anesthesia, Gustave Roussy Cancer Campus, 94080 Villejuif, France
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2
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Sidebotham D, Frampton C. Sugammadex and neostigmine: when better may not be best. Anaesthesia 2023; 78:557-560. [PMID: 36599659 DOI: 10.1111/anae.15961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 01/06/2023]
Affiliation(s)
- D Sidebotham
- Department of Anaesthesia and the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand.,University of Auckland, Auckland, New Zealand
| | - C Frampton
- Department of Medicine, University of Otago, Christchurch, New Zealand
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Effect of neuromuscular reversal with neostigmine/glycopyrrolate versus sugammadex on postoperative ileus following colorectal surgery. Tech Coloproctol 2023; 27:217-226. [PMID: 36064986 PMCID: PMC9898426 DOI: 10.1007/s10151-022-02695-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 08/24/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Postoperative ileus (POI) is a common complication following colorectal surgery and is mediated in part by the cholinergic anti-inflammatory pathway (CAIP). Neostigmine (acetylcholinesterase inhibitor), co-administered with glycopyrrolate, is frequently given for neuromuscular reversal before tracheal extubation and modulates the CAIP. An alternative reversal agent, sugammadex (selective rocuronium or vecuronium binder), acts independently from the CAIP. The aim of our study was to assess the impact of neuromuscular reversal agents used during anaesthesia on gastrointestinal recovery. METHODS Three hundred thirty-five patients undergoing elective colorectal surgery at the Royal Adelaide Hospital between January 2019 and December 2021 were retrospectively included. The primary outcome was GI-2, a validated composite measure of time to diet tolerance and passage of stool. Demographics, 30-day complications and length of stay were collected. Univariate and multivariate analyses were performed. RESULTS Two hundred twenty-four (66.9%) patients (129 [57.6%] males and 95 [42.4%] females, median age 64 [19-90] years) received neostigmine/glycopyrrolate and 111 (33.1%) received sugammadex (62 [55.9%] males and 49 [44.1%] females, median age 67 [18-94] years). Sugammadex patients achieved GI-2 sooner after surgery (median 3 (0-10) vs. 3 (0-12) days, p = 0.036), and reduced time to first stool (median 2 (0-10) vs. 3 (0-12) days, p = 0.035). Rates of POI, complications and length of stay were similar. On univariate analysis, POI was associated with smoking history, previous abdominal surgery, colostomy formation, increased opioid use and postoperative hypokalaemia (p < 0.05). POI was associated with increased complications, including anastomotic leak and prolonged hospital stay (p < 0.001). On multivariate analysis, neostigmine, bowel anastomoses and increased postoperative opioid use (p < 0.05) remained predictive of time to GI-2. CONCLUSIONS Patients who received sugammadex had a reduced time to achieving first stool and GI-2. Neostigmine use, bowel anastomoses and postoperative opioid use were associated with delayed time to achieving GI-2.
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Bailey CR. Neuromuscular blockade in the ICU: if you can't measure it, you can't manage it. Anaesthesia 2022; 77:953-955. [PMID: 35837837 DOI: 10.1111/anae.15809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 11/26/2022]
Affiliation(s)
- C R Bailey
- Department of Anaesthetics, Guy's and St. Thomas' NHS Foundation Trust, London, UK
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Muedra V, Rodilla V, Llansola M, Agustí A, Pla C, Canto A, Hernández-Rabaza V. Potential Neuroprotective Role of Sugammadex: A Clinical Study on Cognitive Function Assessment in an Enhanced Recovery After Cardiac Surgery Approach and an Experimental Study. Front Cell Neurosci 2022; 16:789796. [PMID: 35264931 PMCID: PMC8900639 DOI: 10.3389/fncel.2022.789796] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/07/2022] [Indexed: 12/11/2022] Open
Abstract
Background Postoperative cognitive dysfunction affects the quality of recovery, particularly affecting the elderly, and poses a burden on the health system. We hypothesize that the use of sugammadex (SG) could optimize the quality of postoperative cognitive function and overall recovery through a neuroprotective effect. Methods A pilot observational study on patients undergoing cardiac surgery with enhanced recovery after cardiac surgery (ERACS) approach, was designed to compare SG-treated (n = 14) vs. neostigmine (NG)-treated (n = 7) patients. The Postoperative Quality Recovery Scale (PQRS) was used at different times to evaluate cognitive function and overall recovery of the patients. An online survey among anesthesiologists on SG use was also performed. Additionally, an animal model study was designed to explore the effects of SG on the hippocampus. Results Sugammadex (SG) was associated with favorable postoperative recovery in cognitive domains particularly 30 days after surgery in patients undergoing aortic valve replacement by cardiopulmonary bypass and the ERACS approach; however, it failed to demonstrate a short-term decrease in length of intensive care unit (ICU) and hospital stay. The survey information indicated a positive appreciation of SG recovery properties. SG reverts postoperative memory deficit and induces the expression of anti-inflammatory microglial markers. Conclusion The results show a postoperative cognitive improvement by SG treatment in patients undergoing aortic valve replacement procedure by the ERACS approach. Additionally, experimental data from an animal model of mild surgery confirm the cognitive effect of SG and suggest a potential effect over glia cells as an underlying mechanism.
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Affiliation(s)
- Vicente Muedra
- Department of Medicine and Surgery, Faculty of Health Sciences, Institute of Biomedical Sciences, CEU Cardenal Herrera University, CEU Universities, Valencia, Spain
- Department of Anesthesiology, Intensive Care Unit and Pain Therapy, University La Ribera Hospital, Valencia, Spain
- *Correspondence: Vicente Muedra,
| | - Vicent Rodilla
- Department of Pharmacy, Faculty of Health Sciences, Institute of Biomedical Sciences, Cardenal Herrera CEU University, CEU Universities, Valencia, Spain
| | - Marta Llansola
- Neurobiology Laboratory, Centro de Investigación Príncipe Felipe (CIPF), Valencia, Spain
| | - Ana Agustí
- Nutrition and Health Research Unit, Department of Microbial Ecology, Institute of Agrochemistry and Food Technology, Spanish Council for Scientific Research (IATA-CSIC), Valencia, Spain
| | - Clara Pla
- Department of Anesthesiology, Intensive Care Unit and Pain Therapy, University La Ribera Hospital, Valencia, Spain
| | - Antolín Canto
- Department of Biomedical Sciences, Faculty of Health Sciences, Institute of Biomedical Sciences, Cardenal Herrera CEU University, CEU Universities, Valencia, Spain
| | - Vicente Hernández-Rabaza
- Department of Biomedical Sciences, Faculty of Health Sciences, Institute of Biomedical Sciences, Cardenal Herrera CEU University, CEU Universities, Valencia, Spain
- Vicente Hernández-Rabaza,
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Olesnicky BL, Trumper R, Chen V, Culwick MD. The use of sugammadex in critical events in anaesthesia: A retrospective review of the webAIRS database. Anaesth Intensive Care 2022; 50:220-226. [PMID: 35172631 DOI: 10.1177/0310057x211039859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sugammadex has been used for more than ten years in Australia and New Zealand and has been implicated as an effective treatment, and in some cases a potential cause, of a critical incident. We aimed to identify and analyse critical incidents involving sugammadex reported to webAIRS, a de-identified voluntary online critical incident reporting system in Australia and New Zealand. We identified 116 incidents where the reporter implicated sugammadex as either a cause (23 cases) or a treatment (93 cases) during anaesthesia. There were 17 incidents suggestive of sugammadex anaphylaxis, although not all were confirmed by skin testing. There were six incidents when bradycardia was temporally related to sugammadex administration, although it was not possible to exclude other causes or contributory factors. There were nine incidents in which sugammadex was used to reverse aminosteroid-related neuromuscular blockade successfully in a 'can't intubate, can't oxygenate' (CICO) situation, and a further 67 incidents in which sugammadex was used to reverse aminosteroid neuromuscular blockade as part of the management of other critical incidents. While sugammadex was used during the management of 16 cases of anaphylaxis, there was no clear indication that this altered the course of the anaphylaxis in any of the cases. These reports indicate that sugammadex can be a potential trigger for anaphylaxis and that its use may be associated with the development of significant bradycardia. However, it is not possible to estimate or even speculate on the incidence of these sugammadex-related incidents on the basis of voluntary reporting to a database such as webAIRS. The reports also indicate that sugammadex has been used successfully to reverse residual or deep aminosteroid neuromuscular blockade in critical incident situations and to help rescue CICO scenarios. These findings provide further support for ensuring the ready availability of sugammadex wherever aminosteroid muscle relaxants are used.
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Affiliation(s)
- Benjamin L Olesnicky
- Department of Anaesthesia, 60086Royal North Shore Hospital, Royal North Shore Hospital, St Leonards, Australia.,School of Medicine, 4334The University of Sydney, The University of Sydney, Sydney, Australia
| | - Rosie Trumper
- Department of Anaesthesia, 60086Royal North Shore Hospital, Royal North Shore Hospital, St Leonards, Australia
| | - Vanessa Chen
- Department of Anaesthesia, 60086Royal North Shore Hospital, Royal North Shore Hospital, St Leonards, Australia
| | - Martin D Culwick
- Department of Anaesthesia, Royal Brisbane and Women's Hospital, The University of Queensland, Herston, Australia.,Australian and New Zealand Tripartite Anaesthetic Data Committee, Australia
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Lee HY, Jung KT. Advantages and pitfalls of clinical application of sugammadex. Anesth Pain Med (Seoul) 2020; 15:259-268. [PMID: 33329823 PMCID: PMC7713848 DOI: 10.17085/apm.19099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 05/25/2020] [Accepted: 06/02/2020] [Indexed: 12/18/2022] Open
Abstract
Sugammadex, a modified γ-cyclodextrin, is one of the drugs focused on in the anesthetic field because it provides rapid and complete reversal from neuromuscular blockade (NMB) by encapsulating rocuronium. Its introduction has revolutionized anesthesia practice because it is a safe, predictable, and reliable neuromuscular antagonist. Hence, its use has increased worldwide. Further, it has been in the spotlight for recovering from deep NMB in laparoscopic surgery and improving the surgical condition. Recently, studies have been conducted on the postoperative outcome after deep NMB and use of sugammadex in various clinical conditions. However, with increase in sugammadex use, reports regarding its complications are increasing. Appropriate dosing of sugammadex with quantitative neuromuscular monitoring is emphasized because under-dosing or over-dosing of sugammadex might be associated with unexperienced complications. Sugammadex is now leaping into an ideal reversal agent, changing the anesthesia practice.
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Affiliation(s)
- Hyung Young Lee
- Department of Anesthesiology and Pain Medicine, Chosun University Hospital, School of Medicine, Chosun University, Gwangju, Korea
| | - Ki Tae Jung
- Department of Anesthesiology and Pain Medicine, Chosun University Hospital, School of Medicine, Chosun University, Gwangju, Korea
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Kim NY, Koh JC, Lee KY, Kim SS, Hong JH, Nam HJ, Bai SJ. Influence of reversal of neuromuscular blockade with sugammadex or neostigmine on postoperative quality of recovery following a single bolus dose of rocuronium: A prospective, randomized, double-blinded, controlled study. J Clin Anesth 2019; 57:97-102. [DOI: 10.1016/j.jclinane.2019.02.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/30/2019] [Accepted: 02/12/2019] [Indexed: 01/08/2023]
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Cheaper drugs and techniques to fulfill chief executive officer perspectives - any choices? Curr Opin Anaesthesiol 2019; 32:195-199. [PMID: 30817395 DOI: 10.1097/aco.0000000000000689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Against the background of increasing healthcare costs and diminishing budgets, this review aims to present clinicians with ethically viable options to overcome budgetary restraints when seeking to introduce novel products. RECENT FINDINGS Healthcare administrators and primary healthcare providers are not unlikely to have different opinions when discussing the introduction of novel products. However, rather than taking a 'no' for an answer, doctors may be able to argue for a change - even if this may seem to come at a higher cost. The recent introduction of the reversal agent sugammadex may provide a timely example for the possibility of success 'against all financial odds'. SUMMARY Health professionals have the responsibility to deliver high-quality care while acknowledging the financial budget constraints. However, evidence (vs. perception) for outcome benefits of novel drugs or devices should stimulate a robust desire for their timely introduction. Demonstrating actual benefits understandable to administrators, seeking alliances with other medical specialties or patient groups, as well as negotiations with the healthcare industry may all represent viable options. Simply waiting for patents to expire should remain a measure of last resort.
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Brull SJ, Prielipp RC. Neuromuscular monitoring and the cost of antagonism: when will we learn? Anaesthesia 2019; 72:1557-1558. [PMID: 29130278 DOI: 10.1111/anae.14111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- S J Brull
- Mayo Clinic College of Medicine, Jacksonville, FL, USA
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Bose S, Xu X, Eikermann M. Does reversal of neuromuscular block with sugammadex reduce readmission rate after surgery? Br J Anaesth 2019; 122:294-298. [PMID: 30770044 DOI: 10.1016/j.bja.2018.12.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 12/23/2018] [Accepted: 12/23/2018] [Indexed: 12/20/2022] Open
Affiliation(s)
- Somnath Bose
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Xinling Xu
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Matthias Eikermann
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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Rao SL, Rajan N. Common controversies surrounding anesthesia for procedures in the Interventional Pulmonology Suite. Minerva Anestesiol 2018; 84:1219-1225. [DOI: 10.23736/s0375-9393.18.12673-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Koo BW, Oh AY, Na HS, Lee HJ, Kang SB, Kim DW, Seo KS. Effects of depth of neuromuscular block on surgical conditions during laparoscopic colorectal surgery: a randomised controlled trial. Anaesthesia 2018; 73:1090-1096. [DOI: 10.1111/anae.14304] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2018] [Indexed: 12/25/2022]
Affiliation(s)
- B. W. Koo
- Department of Anesthesiology and Pain Medicine; Seoul National University Bundang Hospital; Seongnam South Korea
| | - A. Y. Oh
- Department of Anesthesiology and Pain Medicine; Seoul National University Bundang Hospital; Seongnam South Korea
- Department of Anesthesiology and Pain Medicine; Seoul National University College of Medicine; Seoul South Korea
| | - H. S. Na
- Department of Anesthesiology and Pain Medicine; Seoul National University Bundang Hospital; Seongnam South Korea
| | - H. J. Lee
- Department of Anesthesiology and Pain Medicine; Seoul National University Bundang Hospital; Seongnam South Korea
| | - S. B. Kang
- Department of Surgery; Seoul National University Bundang Hospital; Seongnam South Korea
| | - D. W. Kim
- Department of Surgery; Seoul National University Bundang Hospital; Seongnam South Korea
| | - K. S. Seo
- Department of Dental Anesthesiology; Seoul National University Dental Hospital; Seoul South Korea
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Affiliation(s)
- R Williams
- Queen Alexandra Hospital, Portsmouth, UK
| | - H Bryant
- Queen Alexandra Hospital, Portsmouth, UK
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Hristovska AM, Duch P, Allingstrup M, Afshari A. The comparative efficacy and safety of sugammadex and neostigmine in reversing neuromuscular blockade in adults. A Cochrane systematic review with meta-analysis and trial sequential analysis. Anaesthesia 2017; 73:631-641. [DOI: 10.1111/anae.14160] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2017] [Indexed: 12/14/2022]
Affiliation(s)
- A.-M. Hristovska
- Department of Pediatric and Obstetric Anaesthesia; Juliane Marie Centre; Copenhagen University Hospital; Copenhagen Denmark
| | - P. Duch
- Department of Neuroanaesthesia; Juliane Marie Centre; Copenhagen University Hospital; Copenhagen Denmark
| | - M. Allingstrup
- Department of Pediatric and Obstetric Anaesthesia; Juliane Marie Centre; Copenhagen University Hospital; Copenhagen Denmark
| | - A. Afshari
- Department of Pediatric and Obstetric Anaesthesia; Juliane Marie Centre; Copenhagen University Hospital; Copenhagen Denmark
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Bailey CR. Neuromuscular monitoring and the cost of antagonism: when will we learn? A reply. Anaesthesia 2017; 72:1559-1560. [DOI: 10.1111/anae.14125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- C. R. Bailey
- Guys and St. Thomas' NHS Foundation Trust; London UK
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