Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2007
Randomized Controlled Trial Comparative StudySugammadex reversal of rocuronium-induced neuromuscular blockade: a comparison with neostigmine-glycopyrrolate and edrophonium-atropine.
Time to achieve full reversal (TOFR > 0.9) was significantly faster with sugammadex (107s ± 61) than neostigmine (1044 ±590s) or edrophonium (331s ± 27).
All sugammadex-reversed patients were completely reversed within 5 minutes, compared with no patients receiving neostigmine.
Reversal with sugammadex lead to less increase in heart-rate than when neostigmine-glycopyrrolate or edrophonium-atropine and almost total avoidance of the dry-mouth associated with the later (5% vs 85-95%)
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Anesthesia and analgesia · Mar 2007
EditorialSugammadex: an opportunity to change the practice of anesthesiology?
Miller enthusiastically states:
“Sugammadex is likely the most exciting drug in clinical neuromuscular pharmacology since the introduction of atracurium and vecuronium in the middle 1980s.”
...and hints at where benefits may begin:
summary“Will sugammadex’s increased effectiveness, in comparison to neostigmine, lessen the need for or use of monitoring neuromuscular function?”
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Anesthesia and analgesia · Mar 2007
An analysis of transfusion practice and the role of intraoperative red blood cell salvage during cesarean delivery.
We sought to determine to what extent intraoperative salvaged red blood cells (RBC) might theoretically reduce exposure to appropriately transfused allogenic erythrocytes in Cesarean delivery patients. ⋯ Theoretically, based on best, average, and worst RBC salvage recovery calculations, 25.1%, 21.2%, or 14.5% of the appropriately transfused patients, respectively, could have completely avoided allogenic RBC transfusion.
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Anesthesia and analgesia · Mar 2007
Case ReportsA temporary decrease in twitch response during reversal of rocuronium-induced muscle relaxation with a small dose of sugammadex.
We present a case in which a temporary decrease in train-of-four (TOF) response was observed after reversal of muscle relaxation with a small dose (0.5 mg/kg) of sugammadex administered 42 min after 0.9 mg/kg of rocuronium. At the end of the operation, the TOF ratio was >0.9, and the patient woke normally, without signs of muscle weakness. We describe this temporary decrease in muscle response during muscle relaxation reversal as muscle relaxation rebound and hypothesize that it occurs when the dose of sugammadex is sufficient for complex formation with rocuronium in the central compartment, but insufficient for redistribution of rocuronium from peripheral to central compartments. ⋯ Sufficiently large doses of sugammadex eliminate the possibility for muscle relaxation rebound, which does not require dissociation of the sugammadex/ rocuronium complex.
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Anesthesia and analgesia · Mar 2007
Randomized Controlled Trial Multicenter StudyReversal of rocuronium-induced neuromuscular block with the novel drug sugammadex is equally effective under maintenance anesthesia with propofol or sevoflurane.
In this study we investigated whether the novel reversal drug, sugammadex, is equally effective at reversing rocuronium-induced neuromuscular block (NMB) in patients under propofol or sevoflurane maintenance anesthesia. After receiving propofol for induction, patients were randomized to propofol (n = 21) or sevoflurane (n = 21). Rocuronium 0.6 mg/kg was administered for tracheal intubation. ⋯ There were no treatment-related serious adverse events and no discontinuations or deaths. No residual paralysis occurred. The safety profile of sugammadex was somewhat more favorable under propofol than under sevoflurane anesthesia.