Sugammadex

Uso de sugammadex en situación de no poder intubar-no poder ventilar


Use of sugammadex in a 'can't intubate, can't ventilate' situation.
Curtis R, Lomax S, Patel B.
Department of Anaesthesia, Royal Surrey County Hospital, Guildford GU2 7XX, UK.
Br J Anaesth. 2012 Apr;108(4):612-4. doi: 10.1093/bja/aer494. Epub 2012 Jan 26.
Abstract
A 78-yr-old woman presented for a panendoscopy to investigate dysphonia and dysphagia. Intubation was anticipated to be difficult but possible, and mask ventilation was anticipated to be possible. After induction of anaesthesia and after three attempts at intubation, a 'can't intubate, can ventilate' situation deteriorated to a 'can't intubate, can't ventilate' (CICV) situation. Rocuronium-induced neuromuscular block was successfully reversed with sugammadex, as evidenced by the restoration of diaphragmatic movement, the ability of the patient to move her limbs, and the presence of a train-of-four nerve stimulation with no fade; however, ventilation was still not possible. A cricothyroid puncture using a Ravussin needle was performed successfully to provide emergency oxygenation. A tracheostomy was performed to allow the panendoscopy. CICV situations are rare anaesthetic emergencies. While sugammadex can be relied upon to reverse rocuronium-induced neuromuscular block, it should not be relied upon to rescue all CICV events, especially where airway instrumentation has led to airway swelling. The availability of sugammadex does not obviate the need for emergency tracheal access in the event of failed oxygenation. The presence of head and neck pathology should lead to the consideration of securing the airway awake.
http://bja.oxfordjournals.org/content/108/4/612.full.pdf




Uso exitoso de sugammadex en el caso de no poder ventilar

Successful use of sugammadex in a 'can't ventilate' scenario
L. Paton, S. Gupta, and D. Blacoe
Anaesthetic Department, Monklands Hospital, Airdrie, UK
Anaesthesia 2013, 68, 861-864
Summary
A 53-year-old man with hypopharyngeal stenosis following curative chemoradiotherapy for a tongue base tumour presented three years later for an attempt at pharyngeal dilatation. The first attempt 6 months previously was abandoned when awake fibreoptic intubation failed due to partial airway obstruction and desaturation when the fibrescope was advanced. As mask ventilation was anticipated to be possible, a further attempt at intubation after induction of anaesthesia was judged appropriate. The backup plan was jet ventilation via a cricothyroid cannula sited pre-induction. However, neither mask nor jet ventilation proved possible after the induction of anaesthesia and neuromuscular blockade with rocuronium. Swift administration of sugammadex on a background of thorough pre-oxygenation allowed return of spontaneous breathing before the development of hypoxia and so avoided the need for surgical airway rescue. This case demonstrates the utility of sugammadex in restoring spontaneous respiration in a 'can't ventilate'scenario, provided that the airway has not been traumatised by instrumentation
http://onlinelibrary.wiley.com/doi/10.1111/anae.12338/pdf






Reversión del bloqueo neuromuscular con sugammadex en un obeso mórbido con miastenia gravis
Neuromuscular block reversal with sugammadex in a morbidly obese patient with myasthenia gravis.
Jakubiak J, Gaszyński T, Gaszyński W.
jakubiakj@yahoo.com.
Anaesthesiol Intensive Ther. 2012 Jan-Mar;44(1):28-30.
Abstract
BACKGRAOUND: Myasthenia gravis is a rare immunological illness that impairs neuromuscular transmission. Myasthenic patients are usually hypersensitive to non-depolarising muscle relaxants, and reversal with neostigmine is rarely effective. We report the successful reversal of rocuroniuminduced neuromuscular block in a morbidly obese myasthenic patient. CASE REPORT: A 38-year-old morbidly obese (body weight 160 kg, BMI 48.8 kg m²) woman was scheduled for elective laparoscopic gastric banding. She was anaesthetised with propofol-based TIVA; intubation was facilitated by 24 mg of rocuronium. After spontaneous recovery of T1, she received 200 mg of sugammadex, which completely restored the NMT ratio (TOF=100%) within 2 min and 48 sec., and she was extubated. No postoperative complications were observed. CONCLUSION: Sugammadex can be successfully used in myasthenic patients, allowing for the safe use of muscle relaxants in these patients.

http://czasopisma.viamedica.pl/ait/article/view/34977/25481



Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org