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Applied Clinical Pharmacology
Published in Elizabeth Combeer, The Final FRCA Short Answer Questions, 2019
The pass rate is disappointing as these agents are ‘meat and drink’ to the profession. The mechanisms by which the action of rocuronium spontaneously degrades were poorly understood. Sugammadex may not be readily available in some Trusts but it is reasonable to expect specialist trainee anaesthetists to understand its pharmacology and clinical usage.
Recognition and Management of the Difficult Airway
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Valerie Cunningham, Alistair McNarry
In a can’t intubate and can’t ventilate scenario (CICV), and if it is known that the patient has normal airway anatomy or no airway pathology, it may be a consideration to follow the ‘awaken patient’ limb of the algorithm. If a non-depolarizing muscle relaxant has been given Sugammadex, a modern reversal agent should be administered and anaesthesia discontinued. Sugammadex is a synthetic modified gamma-cyclodextrin. It is the only selective binding agent that provides rapid reversal of the neuromuscular blockers rocuronium and vecuronium. It should be given in a dose of 16 mg /kg for reversal of neuromuscular blockade within approximately 7 minutes of administration of vecuronium or rocuronium. Careful consideration may be given to reversal of benzodiazepines or opiates to increase the speed of emergence.
Muscle relaxants
Published in Daniel Cottle, Shondipon Laha, Peter Nightingale, Anaesthetics for Junior Doctors and Allied Professionals, 2018
Sugammadex is a new agent, developed specifically to reverse the effects of the non-depolarising drug, rocuronium. The molecule resembles a ring doughnut in shape, the centre of which strongly binds rocuronium, preventing its action at the NMJ. Having a potent reversal agent for rocuronium is useful in emergency situations where the anaesthetist wants the patient to resume spontaneous breathing as quickly as possible.
Effectiveness of Sugammadex on muscle relaxant reversal in preterm neonates
Published in Egyptian Journal of Anaesthesia, 2023
Ahmed Mohamed Ahmed Elshafie, Ahmed Ezzat Marzouq Sad Elrouby, Yasser Mohamed Osman
A selective muscle relaxant binding agent is called sugammadex. Sugammadex is a hydrophilic exterior that promotes solubility and a hydrophobic interior that encapsulates amino steroidal medicines. It is a donut-shaped cyclodextrin molecule. [3,4] Sugammadex binds to rocuronium with the highest affinity, but it also has a three-fold lower affinity for vecuronium. [5] Pancuronium is not much affected, while the benzylisoquinoliums and succinylcholine classes of muscle relaxants are unaffected. Acetylcholinesterase inhibitors like neostigmine, which compete to stop the breakdown of acetylcholine rather than directly opposing neuromuscular blockers, have long been the go-to antagonists. [6] Because Sugammadex interacts directly with steroidal relaxants, it is the only medicine now on the market that can reverse profound neuromuscular blockade. [6]
Are We Ready for an Optimal Neuromuscular Block Management for Neural Monitoring during Thyroid Surgery?
Published in Journal of Investigative Surgery, 2021
The clinical application shows with low-dose sugammadex (0.5 mg/kg) provided timely and high-quality laryngeal EMG signal after average of 18.5 min from sugammadex injection). The presence of the EMG signal after intubation can be an issue for many surgeons. When operative time is short. Many surgeons might consider that in their practice they obtain V1 stimulation on the first side most commonly at 10–15 min from skin incision and the entire duration of surgery is 50–60 min on average. I believe that we need to have “adaptative” protocols according to each patient and surgical team and previous experience. In fact, sugammadex injection can be adjusted by the surgeon’s preference according to the different surgical experience, disease difficulty and expected surgical time. Previous protocols have been published but we need to be more adaptative and eventually give a “tailored” protocol according to clinical situation, patients characteristics and surgical team performance [2,3].
Precision Neuromuscular Block Management for Neural Monitoring During Thyroid Surgery
Published in Journal of Investigative Surgery, 2021
I-Cheng Lu, Sheng-Hua Wu, Pi-Ying Chang, Pi-Yang Ho, Tzu-Yen Huang, Yi-Chu Lin, Dipti Kamani, Gregory W. Randolph, Gianlorenzo Dionigi, Feng-Yu Chiang, Che-Wei Wu
Sugammadex dosage to prevent postoperative residual curarization is well defined according to peripheral nerve response (TOF ratio). During monitored parotid or thyroid surgery, a dose of 2 mg/kg sugammadex could induce nearly complete NMB recovery within 10 minutes.17,19 Since muscle relaxation is also required during surgery, complete neuromuscular function recovery may not be the best management protocol. The main purpose of this study was to investigate suitable dosage and timing of sugammadex administration. We confirmed that low-dose sugammadex (0.5 mg/kg) was effective for obtain an excellent EMG response at the first vagus nerve stimulation (V1) in both porcine model and clinical application. Mean time required to obtain 50% recovery of EMG signal in piglets was 16.8 minutes. In the human surgical setting, the timing of sugammadex administration was designed at 10 minutes after skin incision. On an average, initial vagal stimulation V1 was obtained at 28.5 minutes after skin incision. This duration ranged variously from 11 to 55 minutes. Our hospital served as a referral center and received patients with higher surgical difficulty such cancer, large goiter or repeated surgery. Those surgical steps required much more time than common thyroid surgery. The protocol showed that partial recovery of neuromuscular function (averaged TOF >58%) was feasible for high-quality V1 EMG signal (mean amplitude 1214 μV with standard waveform) during monitored thyroidectomy.