• Anaesth Intensive Care · Mar 2012

    Editorial

    Sugammadex: restricted vs unrestricted or selective vs non-selective?

    Neville Gibbs and Peter Kam outline three evidence-based indications for use of sugammadex in 2012, even with its high cost:

    1. Early reversal of rocuronium when suxamethonium is contraindicated. For example in ECT for patients with a pseudocholinesterase deficiency or neuromuscular denervation conditions.

    2. Reversal of rocuronium when even very mild residual neuromuscular block carries significant patient risk. For example, patients with neuromuscular disorders such as myotonic dystrophy or myasthenia gravis; and patients with severe pulmonary disease with limited reserve.

    3. Unplanned early reversal of rocuronium during a failed intubation where rapid reversal may allow awakening of the patient.

    4. Rescue from residual paralysis despite having given neostigmine.

    summary
    • N M Gibbs and P C A Kam.
    • Anaesth Intensive Care. 2012 Mar 1;40(2):213-5.

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    This article appears in the collection: Is sugammadex as good as we think?.

    Notes

    summary
    1

    Neville Gibbs and Peter Kam outline three evidence-based indications for use of sugammadex in 2012, even with its high cost:

    1. Early reversal of rocuronium when suxamethonium is contraindicated. For example in ECT for patients with a pseudocholinesterase deficiency or neuromuscular denervation conditions.

    2. Reversal of rocuronium when even very mild residual neuromuscular block carries significant patient risk. For example, patients with neuromuscular disorders such as myotonic dystrophy or myasthenia gravis; and patients with severe pulmonary disease with limited reserve.

    3. Unplanned early reversal of rocuronium during a failed intubation where rapid reversal may allow awakening of the patient.

    4. Rescue from residual paralysis despite having given neostigmine.

    Daniel Jolley  Daniel Jolley
    comment
    0

    As the evidence-base increases and the cost falls, it will be indications #2 and #4 that carry our shift in practice to using sugammadex and its successors. We will recognise larger groups of patients for whom residual paralysis is detrimental (everyone?) while simultaneously appreciating better how common the problem truly is.

    Daniel Jolley  Daniel Jolley
     
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