Monitoreo neuromuscular, uso de relajantes musculares, y su reversión en un hospital de tercer nivel 2.5. años después de la introducción de sugammadex. Cambios en opiniones y práctica clínica
Neuromuscular monitoring, muscle relaxant use, and reversal at a tertiary teaching hospital 2.5 years after introduction of sugammadex: changes in opinions and clinical practice. Ledowski T, Ong JS, Flett T. Anesthesiol Res Pract. 2015;2015:367937. doi: 10.1155/2015/367937. Epub 2015 Jan 22. Abstract Sugammadex was introduced to Royal Perth Hospital in early 2011 without access restriction. Two departmental audits (26-page online survey and 1-week in-theatre snapshot audit) were undertaken to investigate the change of beliefs and clinical practice related to the use of neuromuscular blocking agents at the Royal Perth Hospital since this introduction. Results were compared with data from 2011. We found that, in the 2.5 years since introduction of Sugammadex, more anesthetists (69.5 versus 38%) utilized neuromuscular monitoring, and aminosteroidal neuromuscular blocking agents were used in 94.3% of cases (versus 77% in 2011). Furthermore, 53% of anesthetists identified with a practice of "deeper and longer" intraoperative paralysis of patients. All 71 patients observed during the 5-day in-theatre audit were reversed with Sugammadex. Since the introduction of Sugammadex, 69% (n = 20) of respondents felt it provided "faster turnover," less postoperative residual neuromuscular blockade (n = 23; 79%), and higher anesthetist satisfaction (n = 17; 59%). 45% (n = 13) of colleagues reported that they would feel professionally impaired without the unrestricted availability of Sugammadex, and 1 colleague would refuse to work in a hospital without this drug being freely available. In clinical practice Sugammadex was frequently (57%) mildly overdosed, with 200 mg being the most commonly administered dose.
Evaluación biológica del efecto de sugammadex sobre la hemostasis y el sangrado
Biological evaluation of the effect of sugammadex on hemostasis and bleeding.
Raft J, Guerci P, Harter V, Fuchs-Buder T, Meistelman C. Korean J Anesthesiol. 2015 Feb;68(1):17-21. doi: 10.4097/kjae.2015.68.1.17. Epub 2015 Jan 28.
BACKGROUND: Notification of sugammadex has been supplemented with a section on hemostasis, including a longer clotting time in the first minutes following injection, without any documented clinical consequences. The objective of this observational study was to analyze the effects ofsugammadex administration on routine coagulation tests and bleeding in the clinical setting. METHODS: After Institutional Review Board approval, a prospective observational study was conducted between January and December 2011. Adult patients scheduled for laparotomies were analyzed in groups according to the type of reversal (without sugammadex versus 2 or 4 mg/kgsugammadex). There were no changes in our current clinical practice. Blood samples drawn from these patients were standardized at the same time and tested using the same daily calibrated machine. The endpoint was a comparison of the activated partial thromboplastin time (aPTT), prothrombin time (PT), hemoglobin (Hb) level and hematocrit (Ht), immediately before sugammadex administration (H0) and 1 h after neuromuscular block reversal (H1). RESULTS: One hundred and forty-two patients in three groups were included as follows: 11 in the "without sugammadex" group, 64 in the "2 mg/kgsugammadex" group and 67 in the "4 mg/kg sugammadex" group. Results did not differ significantly among the groups. CONCLUSIONS: In this prospective observational study, the use of 2 and 4 mg/kg sugammadex was not associated with a longer clotting time or decreased hemoglobin concentrations. Future prospective investigations should study patients receiving 16 mg/kg sugammadex and/or with abnormal coagulation tests. KEYWORDS: Activated partial thromboplastin time; Hemostasis; Prothrombin time; Sugammadex