En la hora del sugamadex
In the hour of Sugammadex.
Chon JY.
Department of Anesthesiology and Pain Medicine, The Catholic University of Korea School of Medicine, Seoul, Korea.
Korean J Anesthesiol. 2013 Jan;64(1):3-5. doi: 10.4097/kjae.2013.64.1.3. Epub 2013 Jan 21.
Abstract
Sugammadex is a modified gamma-cyclodextrin which is showing favorable outcomes regarding reversal of neuromuscular blockade, especially by rocuronium. It is designed to encapsulate rocuronium and being considered a new class of drugs as selective relaxant binding agents. It has given countless benefits to the patients at risk of incomplete or delayed recovery after neuromuscular block and has renown for another milestone in anesthesia practice. Recurrence of neuromuscular block has not been reported to be associated with the provided doses of sugammadex that are adequate for selected for reversal. Acceptable profiles are brought to light telling safety of sugammadex. However, some questions related to the twitch characteristics those resembled succinylcholine when reversal, the application for rocuronium anaphylaxis, and the hypersensitivity or anaphylaxis to sugammadex remain and are need of further investigation. It is imperative that potential problems that we need attention may include the patient's history of pulmonary disease and allergic disease for using sugammadex.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3558646/pdf/kjae-64-3.pdf
¿Necesitamos sugamadex al final de la anestesia general para revertir la acción de los relajantes musculares?
Do we need to use sugammadex at the end of a general anesthesia to reverse the action of neuromuscular bloking agents?
Della Rocca G, Di Marco P, Beretta L, De Gaudio A, Ori C, Mastronardi P.
Della Rocca Giorgio, Department of Anesthesia and Intensive Care Medicine. University of Udine. Udine,Italy -giorgio.dellarocca@uniud.it.
Minerva Anestesiol. 2012 Nov 29. [Epub ahead of print]
Abstract
Sugammadex, the first selective relaxant-binding agent indicated to reverse the neuromuscular blockade induced during general anesthesia, was recently introduced into clinical practice. In the present report, the following issues pertinent to the use of sugammadex in anesthesia practice are discussed: the intraoperative use of NMBAs and the incidence of postoperative residual curarization (PORC); the efficacy and safety of rocuronium plus sugammadex compared to succinylcholine for rapid sequence induction; the availability of sugammadex in hospitals; and, finally, some relevant legal medical aspects. Sugammadex is considerably more expensive than neostigmine, but its use can be advocated based on its safety and efficacy profile as a reversal agent of steroidal neuro muscular blocking agents (NMBAs), and as a mean to prevent PORC. The availability of sugammadex in Italian hospitals may have a beneficial impact on patient safety. This is due to the fact that PORC is a common and dangerous condition that may lead to postoperative inhalational events, hypoxemia, and pneumonia; and at the moment, it is not completely preventable even when advanced neuromuscolar monitoring techniques are applied." In the case of rapid sequence intubation (RSI), rocuronium (1.2 mg/Kg) administration followed by sugammadex represents a better choice in terms of efficacy and safety than succinylcholine. If a new drug is proven to be safer and more efficient than the one it is replacing, hospitals should consider the new drug and make it available, at least for selected patients or in situations at risk of severe complications. It's reasonable to hypothesize that, when discussing informed consent for elective procedures, patients and families may want to know if the admitting facilities have the superior agent available, and that the absence of such agent could create concerns and complains.
http://www.minervamedica.it/en/getfreepdf/eoHHZVuc7DofWra1EXMD3a
SjN1kypdvnwGvPz%252BBe87XFunsM0oS8l0i2lm5k70uOKMaoa0QcO0Ft9vHOChIrlw%253D%253D/R02Y9999N00A0508.pdf
Atentamente
Dr. Juan C. Flores-Carrillo
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
In the hour of Sugammadex.
Chon JY.
Department of Anesthesiology and Pain Medicine, The Catholic University of Korea School of Medicine, Seoul, Korea.
Korean J Anesthesiol. 2013 Jan;64(1):3-5. doi: 10.4097/kjae.2013.64.1.3. Epub 2013 Jan 21.
Abstract
Sugammadex is a modified gamma-cyclodextrin which is showing favorable outcomes regarding reversal of neuromuscular blockade, especially by rocuronium. It is designed to encapsulate rocuronium and being considered a new class of drugs as selective relaxant binding agents. It has given countless benefits to the patients at risk of incomplete or delayed recovery after neuromuscular block and has renown for another milestone in anesthesia practice. Recurrence of neuromuscular block has not been reported to be associated with the provided doses of sugammadex that are adequate for selected for reversal. Acceptable profiles are brought to light telling safety of sugammadex. However, some questions related to the twitch characteristics those resembled succinylcholine when reversal, the application for rocuronium anaphylaxis, and the hypersensitivity or anaphylaxis to sugammadex remain and are need of further investigation. It is imperative that potential problems that we need attention may include the patient's history of pulmonary disease and allergic disease for using sugammadex.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3558646/pdf/kjae-64-3.pdf
¿Necesitamos sugamadex al final de la anestesia general para revertir la acción de los relajantes musculares?
Do we need to use sugammadex at the end of a general anesthesia to reverse the action of neuromuscular bloking agents?
Della Rocca G, Di Marco P, Beretta L, De Gaudio A, Ori C, Mastronardi P.
Della Rocca Giorgio, Department of Anesthesia and Intensive Care Medicine. University of Udine. Udine,Italy -giorgio.dellarocca@uniud.it.
Minerva Anestesiol. 2012 Nov 29. [Epub ahead of print]
Abstract
Sugammadex, the first selective relaxant-binding agent indicated to reverse the neuromuscular blockade induced during general anesthesia, was recently introduced into clinical practice. In the present report, the following issues pertinent to the use of sugammadex in anesthesia practice are discussed: the intraoperative use of NMBAs and the incidence of postoperative residual curarization (PORC); the efficacy and safety of rocuronium plus sugammadex compared to succinylcholine for rapid sequence induction; the availability of sugammadex in hospitals; and, finally, some relevant legal medical aspects. Sugammadex is considerably more expensive than neostigmine, but its use can be advocated based on its safety and efficacy profile as a reversal agent of steroidal neuro muscular blocking agents (NMBAs), and as a mean to prevent PORC. The availability of sugammadex in Italian hospitals may have a beneficial impact on patient safety. This is due to the fact that PORC is a common and dangerous condition that may lead to postoperative inhalational events, hypoxemia, and pneumonia; and at the moment, it is not completely preventable even when advanced neuromuscolar monitoring techniques are applied." In the case of rapid sequence intubation (RSI), rocuronium (1.2 mg/Kg) administration followed by sugammadex represents a better choice in terms of efficacy and safety than succinylcholine. If a new drug is proven to be safer and more efficient than the one it is replacing, hospitals should consider the new drug and make it available, at least for selected patients or in situations at risk of severe complications. It's reasonable to hypothesize that, when discussing informed consent for elective procedures, patients and families may want to know if the admitting facilities have the superior agent available, and that the absence of such agent could create concerns and complains.
http://www.minervamedica.it/en/getfreepdf/eoHHZVuc7DofWra1EXMD3a
SjN1kypdvnwGvPz%252BBe87XFunsM0oS8l0i2lm5k70uOKMaoa0QcO0Ft9vHOChIrlw%253D%253D/R02Y9999N00A0508.pdf
Atentamente
Dr. Juan C. Flores-Carrillo
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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