Sugammadex and fast-track anesthesia for pediatric cardiac surgery in a developing country (original) (raw)
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Brazilian Journal of Anesthesiology, 2012
Background and objectives: Sugammadex is a reversal agent that acts as a selective antagonist of neuromuscular blockade induced by rocuronium and vecuronium. This is a case report of an elderly female patient who had sugammadex just after rocuronium induction. Case report: An 88-year-old female patient, 34 kg, presented a femoral fracture and had to undergo general anesthesia after spinal anesthesia failure. Induction was performed with propofol 1.5 mg.kg-1 , rocuronium 1.2 mg.kg-1 , fentanyl 100 mcg, and lidocaine 2 mg.kg-1. There was no success in either tracheal intubation or laryngeal mask positioning maneuvers. The use of sugammadex at a dose of 16 mg.kg-1 was required and respiratory function returned to normal. Conclusion: Literature recommends sugammadex at a dose of 16 mg.kg-1 for patients with profound blockade. It was used in our patient with rapid and effective reversal of neuromuscular blockade allowing the patient to undergo another procedure to ensure the airway patency without clinical impairment of her general condition.
Use of sugammadex in patients with a history of pulmonary disease
Journal of Clinical Anesthesia, 2012
Study Objective: To evaluate the safety and efficacy of sugammadex for reversal of rocuroniuminduced neuromuscular blockade in patients with pulmonary disease. Design: Phase III, randomized, multicenter, parallel-group, comparative, safety-assessor blinded study. Setting: Nine hospital sites. Patients: 77 ASA physical status 2 and 3 patients, aged ≥ 18 years, with a history of pulmonary disease, and scheduled for surgery with general anesthesia requiring neuromuscular blockade. Interventions: Following anesthesia induction, patients received rocuronium 0.6 mg/kg with 0.15 mg/kg maintenance doses as needed. Patients were randomized to receive sugammadex 2 mg/kg or 4 mg/kg after the last rocuronium dose at reappearance of the second twitch. Measurements: Safety evaluations included adverse events, laboratory parameters, vital signs, and evidence of recurrent or residual neuromuscular blockade. Efficacy was evaluated as the time from sugammadex administration to recovery of the train-of-four (TOF) ratio to ≥ 0.9.
International Journal of Case Reports in Medicine, 2013
Tonsillectomy is a frequently performed procedure in children; its common postoperative complication is bleeding. We present a case report of a 6-year-old patient undergoing surgical haemostasis after an acute post-tonsillectomy bleeding. A rapid intubation sequence was performed to reduce the risk of blood inhalation and bronchospasm: fentanyl (1 mcg/kg) and propofol (3mg/Kg) were used for a rapid induction of anaesthesia, and rocuronium (1.2 mg/Kg) was used for neuromuscular block. Neuromuscular function was monitored using the TOF-Watch SX acceleromyography at the adductor thumb muscle. Surgical haemostasis lasted for 12 minutes after rocuronium administration, so the neuromuscular block was still deep (TOF 0, PTC 2). Sugammadex (4mg/Kg) was administered to allow a rapid reversal of the block. After the sugammadex bolus, we started a continuous monitoring with TOF-Watch SX until a TOF ratio of 0.9 was reached. A TOF ratio of 0.9 was reached 3 minutes after the administration of sugammadex. The patient was then extubated in the operating room and monitored in recovery room for 60 minutes. No further complications arose, either in the recovery room or in the ward.
The Importance of Sugammadex at Postoperative Residual Neuromuscular Block
EPRA international journal of multidisciplinary research, 2023
Introduction: postoperative residual neuromuscular blockade is the postoperative muscle paralysis caused by incomplete or null antagonism of neuromuscular blocking agents. Post-surgical residual paralysis (PORP) has a high incidence and may cause adverse effects, increasing postoperative morbidity and mortality. The gold standard for complete reversal of neuromuscular blockade is a T4/T1 ratio of 0.9. Small degrees of paralysis are associated with an increased risk of postoperative pulmonary complications. Recent research indicates that residual neuromuscular blockade is a significant risk factor for patient safety. Objective: to detail the current information related to postoperative residual paralysis, in addition to explaining the use and characteristics of sugammadex in its reversal. Methodology: a total of 45 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 35 bibliographies were used because the other articles were not relevant for this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: postoperative residual neuromuscular block, postoperative muscle weakness, sugammadex, anticholinesterase inhibitors. Results: Neuromuscular block occurs due to muscle fragility in the postoperative period due to antagonism, which produces a decrease in the musculature of the upper and lower airways. When this phase is properly managed, extubation delays are reduced, and postoperative pulmonary complications are reduced. Sugammadex is a relaxant that decreases the possibility of persistent neuromuscular paralysis; as neuromuscular blockade increases, contraction decreases. Therefore, when this drug is used, the risk of adverse effects, mostly respiratory, is avoided. This drug inactivates rocuronium, and the adverse effects it presents (although very infrequent) are dysgeusia, cough, grimacing or increased secretion through the endotracheal tube. Conclusions: sugammadex is suggested to be used before neostigmine, although it should be used in patients with high risk of postoperative complications, such as patients over 80 years of age or with post cardiothoracic surgery. However, sugammadex reverses neuromuscular blockade more rapidly, with a decrease in the frequency of residual neuromuscular blockade and postoperative pulmonary complications such as pneumonias. A point to consider is that sugammadex is more expensive and is usually accompanied by higher presentations of adverse effects.
2019
Introduction: The aim of this study was to compare sugammadex and neostigmine in terms of reversing time, recovery time and extubation time in reversal of rocuronium-induced neuromuscular block in patients undergoing lung resection surgery. Method: A total of 60 patients under 75 years of age with an ASA status of II-III undergoing elective pulmonary resection (lobectomy, pneumectomy, wedge resection) who had adequate left ventricle function (EF >40%), normal renal, hepatic, and mental functions, were included in this study Patients were assigned into neostigmine (Group N, n=30) and sugammadex (Grup S, n=30) groups. Results: Time from starting of neuromuscular blockade reversing agent till reaching TOF>0.9 was significantly shorter in Group S (p=0.001). Similarly, extubation time and recovery time were significantly shorter in Group S (p=0.05; p=0.012, respectively). No statistically significant differences were observed between the two groups in terms of the operation time and duration of ICU stay. Postoperative complications were similar in both groups. Postoperative residual curarisation was not observed in both groups. Conclusion: In lung resection surgery, sugammadex appears to be a superior selective relaxant binding agent as compared to neostigmine in the reversal of rocuronium-induced neuromuscular block with earlier recovery and earlier achievement of TOF ratio of 0.9.
Risk Factors for Rescue Neuromuscular Blockade Reversal Using Sugammadex
Sift Desk Journals, 2022
Background: Previous studies have demonstrated the superiority of sugammadex over neostigmine for reversal of nondepolarizing neuromuscular blockade (NMB) reversal. However, its increased cost over neostigmine remains a barrier to use in many institutions. Aims: The purposes of this study were to compare the outcomes of patients receiving neostigmine alone vs. patients receiving neostigmine and sugammadex and to identify the risk factors for patients requiring sugammadex as a rescue neuromuscular blockade reversal agent. Methods: A retrospective observational study of general anesthesia cases using rocuronium or vecuronium for NMB at a single regional medical center from January 1, 2019 to March 30, 2021 was performed. Demographics, surgical details, and outcomes of patients receiving neostigmine only (N) were compared to those of patients receiving neostigmine followed by sugammadex (NS). A conditional logistic regression model was developed to identify predictors of patients requiring a rescue dose of sugammadex for NMB reversal. Results: A total of 7104 patients were included (N=6684, NS=420). In comparison to patients in the N group, those in the NS group experienced shorter duration from last NMB administration to first reversal, longer PACU recovery times, longer length of stay, and higher rates of reintubation. After risk adjustment, patients receiving NS were more likely to be female, of non-white race, have increased BMIs, and a greater comorbidity burden than those requiring N only. In comparison to patients undergoing general surgery, those undergoing thoracic surgery are at increased risk for requiring NS. A model for predicting which patients would receive NS was generated with an AUC of 0.681 (95% CI: 0.654-0.708), sensitivity of 78% and specificity of 48%. Conclusion: These findings may assist anesthesiologists in identifying which patients are likely to require sugammadex for rescue NMB reversal after use of neostigmine and are therefore suitable candidates for using sugammadex as a first-line therapy. Key Words : Neuromuscular blockade reversal, sugammadex, neostigmine, residual neuromuscular blockade, predictive model Core Tip: After risk adjustment, patients who were female, of non-white race, have increased BMIs, have a greater comorbidity burden, or undergo thoracic surgery are at increased risk for requiring sugammadex after neostigmine. A model for predicting which patients would receive neostigmine and sugammadex was generated with an AUC of 0.681 (95% CI: 0.654-0.708), sensitivity of 78% and specificity of 48%. These findings may assist anesthesiologists in identifying which patients are likely to require sugammadex for rescue NMB reversal after use of neostigmine and are therefore suitable candidates for using sugammadex as a first-line therapy.
Does sugammadex facilitate recovery after outpatient tonsillectomy in children?
Egyptian Journal of Anaesthesia, 2016
Introduction: Sugammadex is an efficient reversal agent at any time, after neuromuscular blockade. It provides complete reversal for light or deep block facilitating rapid airway control and decreases anesthesia recovery period in outpatient surgeries in children. Patient and methods: After ethical committee approval, informed consent and sample size calculation, 70 patients planned for outpatient total bilateral tonsillectomy were divided randomly into 2 groups. Group S (n = 35) received 2 mg/kg sugammadex to reversing NMB achieved by rocuronium. Group N (n = 35) received 0.05 mg/kg neostigmine and atropine sulfate 0.01 mg/kg, and extubation time (time from administration of reversal agent to time of extubation), train-of-four ratio, time to reach train-of-four >0.9, and side effects were recorded. Results: There was no significant difference in demographic variables. TOF ratio after reversing was a statistically less in group S than in group N (p < 0.05). The time when TOF rate exceeded 0.9 and extubation time were less in group S than in group N with significant difference (p < 0.05). No adverse effect was recorded in both groups. Conclusions: Sugammadex has created a novel rapid, effective and reliable retrieval from NMB with rocuronium in children undergoing tonsillectomy with no side effects.