Preparing for the unexpected: special considerations and complications after sugammadex administration

BMC Anesthesiology

Review

Hajime Iwasaki¹  Takayuki Kunisawa¹  J. Ross Renew²  Sorin J. Brull² 

[1] Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, 2-1-1-1 Midorigaoka-higashi, 078-8510, Asahikawa, Hokkaido, Japan;Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, 32224, Florida, USA;

关键词: Neuromuscular blocking drugs;    Neuromuscular function;    Neuromuscular block;    Sugammadex;    Neostigmine;    Pharmacologic reversal;    Anticholinesterase;   

DOI  :  10.1186/s12871-017-0429-9

 received in 2017-05-15, accepted in 2017-10-02,  发布年份 2017

来源: Springer

【 摘 要 】

Sugammadex, a modified gamma-cyclodextrin, has changed clinical practice of neuromuscular reversal dramatically. With the introduction of this selective relaxant binding agent, rapid and reliable neuromuscular reversal from any depth of block became possible. Sugammadex can reverse neuromuscular blockade without the muscarinic side effects typically associated with the administration of acetylcholinesterase inhibitors. However, what remained unchanged is the incidence of residual neuromuscular blockade. It is known that sugammadex cannot always prevent its occurrence, if appropriate dosing is not chosen based on the level of neuromuscular paralysis prior to administration determined by objective neuromuscular monitoring. Alternatively, excessive doses of sugammadex administered in an attempt to ensure full and sustained reversal may affect the effectiveness of rocuronium in case of immediate reoperation or reintubation. In such emergent scenarios that require onset of rapid and reliable neuromuscular blockade, the summary of product characteristics (package insert) recommends using benzylisoquinolinium neuromuscular blocking agents or a depolarizing agent. However, if rapid intubation is required, succinylcholine has a significant number of side effects, and benzylisoquinolinium agents may not have the rapid onset required. Therefore, prior administration of sugammadex introduces a new set of potential problems that require new solutions. This novel reversal agent thus presents new challenges and anesthesiologists must familiarize themselves with specific issues with its use (e.g., bleeding risk, hypermagnesemia, hypothermia). This review will address sugammadex administration in such special clinical situations.

【 授权许可】

CC BY   
© The Author(s). 2017