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Esquina
Cochrane: sugamadex, medicación revertidora selectiva para prevenir el
bloqueo neuromuscular residual
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Cochrane corner: sugammadex, a selective reversal
medication for preventing postoperative residual neuromuscular blockade.
Abrishami A, Ho J, Wong J, Yin L, Chung F.
Abstract
Anesth Analg. 2010 Apr 1;110(4):1239.
BACKGROUND: Sugammadex is the first selective relaxant binding agent that
has been studied for reversal of neuromuscular blockade induced by
rocuronium and other steroidal non-depolarizing neuromuscular blocking
agents (NMBAs). OBJECTIVES: To assess the efficacy and safety of sugammadex
in reversing neuromuscular blockade induced by steroidal non-depolarizing
NMBAs and in preventing postoperative residual neuromuscular blockade.
SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled
Trials (CENTRAL) (The Cochrane Library 2008, Issue 3), MEDLINE (1950 to
August 2008), and EMBASE (1980 to August 2008). In addition, we
handsearched reference lists of relevant articles and meeting abstracts.
Furthermore, we contacted the medication's manufacturer for more
information. SELECTION CRITERIA: All randomized controlled trials (RCTs) on
adult patients (> or = 18 years old) in which sugammadex was compared
with placebo or other medications, or in which different doses of
sugammadex were compared with each other. We excluded non-randomized trials
and studies on healthy volunteers. DATA COLLECTION AND ANALYSIS: We
independently performed determination of trial inclusion, quality
assessment, and data extraction. We applied standard meta- analytic
techniques. MAIN RESULTS: We included18 RCTs (n=1321 patients). Seven
trials were published as full-text papers, and 11 trials only as meeting
abstracts. All the included trials had adequate methods of randomization
and allocation concealment. The results suggest that, compared with placebo
or neostigmine, sugammadex can more rapidly reverse rocuronium-induced
neuromuscular blockade regardless of the depth of the block. We identified
2, 4, and 16 mg/kg of sugammadex for reversal of rocuronium-induced
neuromuscular blockade at T2 reappearance , 1 to 2 post-tetanic counts, and
3 to 5 minutes after rocuronium, respectively. The number of trials are
very limited regarding vecuronium and pancuronium. Serious adverse events
occurred in < 1% of all patients who received the medication. There was
no significant difference between sugammadex and placebo in terms of the
prevalence of drug-related adverse events (RR 1.20, 95% CI 0.61 to 2.37; P=0.59,
I2=0%, 5 RCTs). Also, no significant difference was found between
sugammadex and neostigmine for adverse events (RR 0.98, 95% CI 0.48 to1.98;
P=0.95, I2=43%, 3 RCTs).
AUTHORS' CONCLUSIONS: Sugammadex was shown to be effective in reversing
rocuronium-induced neuromuscular blockade. This review has found no
evidence of a difference in the instance of unwanted effects between
sugammadex, placebo or neostigmine. These results need to be confirmed by
future trials on larger patient populations and with more focus on
patient-related outcomes.
http://www.anesthesia-analgesia.org/content/110/4/1239.2.full.pdf+html
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Reversión
con sugamadex del bloqueo neuromuscular residual profundo inducido con
rocuronio: estudio neurofisiológico.
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Reversal of profound and "deep" residual
rocuronium-induced neuromuscular blockade by sugammadex: a
neurophysiological study.
Pavoni V, Gianesello L, De Scisciolo G, Provvedi E, Horton D, Barbagli R,
Conti P, Conti R, Giunta F.
Staff Anesthesiologist, Department of Critical Medical-Surgical Area,
Section of Anesthesia andIntensive Care, Firenze, Italy2 Department of
Neurophysiology, University-Hospital Careggi, Firenze, Italy3
Administration, Mayo Clinic, Phoenix, USA4 Department of Neurosurgery,
University-Hospital Careggi, Firenze, Italy5 Department of Surgery School
of medicine, University of Pisa, Italy - pvv@unife.it.
Minerva Anestesiol. 2012 Feb 1.
Abstract
BACKGROUND:
Sugammadex is the first of a new class of selective relaxant binding drugs
developed for the rapid and complete reversal of neuromuscular blockade
(NMB) induced by the aminosteroid neuromuscular blocking drugs rocuronium
and vecuronium. Neuromuscular blocking drugs block the transmission from
the peripheral nerve to the muscle units, with reduction and disappearance
of the evoked electromyographic activity. Usually, neuromuscular monitoring
for the investigational reversal drug is performed by calibrated
acceleromyography. The efficacy of sugammadex in reversing profound and
"deep" residual rocuronium-induced NMB using myogenic motor
evoked potentials (mMEPs) monitoring was evaluated. METHODS: In this
prospective trial, 30 consenting patients undergoing propofol-remifentanil
anesthesia for spine surgery were enrolled and divided into two groups:
Group 1, reversal of profound NMB (sugammadex 16 mg/Kg, 3 minutes after
rocuronium 1.2 mg/Kg) and Group 2, reversal of "deep" residual
NMB (sugammadex 4 mg, 15 minutes after rocuronium 0.6 mg/Kg). Myogenic MEPs
registrations of upper and lower limbs and the diaphragm were performed, as
well as TOF monitoring. RESULTS: After injection of 4 mg/Kg of sugammadex,
the means of recovery time of the basal mMEPs amplitudes (diaphragm, and
lower limbs and upper limbs) were 124±9.6, 143±163, 151±207 sec,
respectively whereas after 16 mg/Kg of sugammadex the times were 109±13.8,
124±0.6, and 135±14.1 sec. Times to TOF ratio 0.9 were 114±75 and 186±105
sec in Group 1 and 2, respectively. No serious adverse effects related to
sugammadex and to electrical stimulation were reported. No reoccurrence of
neuromuscular block was observed. CONCLUSION: Neurophysiological monitoring
using mMEPs confirmed that sugammadex provided a complete recovery from
profound and "deep" residual rocuronium- induced neuromuscular
blockade
http://www.minervamedica.it/en/getfreepdf/%252BPf400dnKAf8tErFa7P2UXla5emo3LR8ROHwXflgDsXXQp%252FxQtwuEFzxuDmFs05Vy4hjBUwIl1ZYL%252FqifZC9Aw%253D%253D/R02Y9999N00A0339.pdf
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Manejo
anestésico de un paciente con miastenia gravis para cirugía abdominal
utilizando sugamadex
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Anaesthetic management of a patient with myasthenia gravis for
abdominal surgery using sugammadex.
Rudzka-Nowak A, Piechota M.
Department of Anaesthesiology and Intensive Therapy, Military Medical
Academy University Hospital in Lodz, Medical University of Lodz, Poland.
Arch Med Sci. 2011 Apr;7(2):361-4. Epub 2011 May 17.
Abstract
We report a case of a patient with tumor of the caecum with coexistent
myasthenia gravis (a form according to Osserman II A), requiring general
anesthesia for abdominal surgery. To reverse the neuromuscular block
induced by vecuronium was used sugammadex.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3258733/pdf/AMS-7-2-361.pdf
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