Efficacy of sugammadex compared with neostigmine for reversal of rocuronium-induced neuromuscular blockade and deep extubation in outpatient surgeries for asthmatic pediatric patients
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BackgroundBronchial asthma in children is considered a challenge for the anesthesiologist because of the perioperative adverse effects, especially the risk for bronchospasm either during induction or more commonly during recovery and extubation. Therefore, the goal should be to minimize this risk by avoiding any triggering stimulus and deep extubation with adequate recovery from the neuromuscular blocker to have full control of pharyngeal and respiratory muscles. The aim of this study was to compare the efficacy of sugammadex with neostigmine on reversing rocuronium-induced neuromuscular blockade (NMB) in asthmatic pediatric patients undergoing outpatient surgical procedures.Patients and methodsThis prospective randomized study was conducted on 60 patients, aged 3–12 years, with history of bronchial asthma, and scheduled for outpatient lower abdominal or urogenital surgeries. NMB was achieved by administration of rocuronium 0.6 mg/kg and monitorized subjectively with train-of-four mode of peripheral nerve stimulator. Patients were randomly allocated into two groups by using the sealed-envelope method: group N (n=30), which received 0.04 mg/kg neostigmine, and group S (n=30), which received 2 mg/kg sugammadex for reversal of rocuronium-induced NMB. Duration of surgery, time from injection of the reversal agent to the time of extubation (time to extubation), total doses of rocuronium, and time from extubation to recovery were recorded. Any complications such as hemodynamic abnormalities, retching, vomiting, bucking, bronchospasm, laryngospasm, coughing, need for reintubation, or any other complications were recorded.ResultsThere was no significant difference between the two groups as regards age, sex, weight, duration of surgery, and total doses of rocuronium. On the other hand, there was statistically significant difference between the two groups regarding time of NMB reversal to time of extubation: 13.43±4.92 min in the neostigmine group versus 1.84±0.66 min in the sugammadex group (P<0.0001). Moreover, there was statistically significant difference between the two groups regarding time from extubation till time of recovery: 21±5.72 min in group N versus 25.57±5.72 min in group S (P=0.019). Regarding complications, need for succinylcholine, and need for reintubation, although their incidence was higher in the neostigmine group, there was no statistically significant difference between the two groups.ConclusionIt was concluded that reversal of rocuronium-induced NMB by using sugammadex was more rapid and safer when compared with neostigmine in asthmatic pediatric patients undergoing outpatient lower abdominal or urogenital surgeries.Keywords:
Sugammadex
Laryngospasm
Sugammadex
Neuromuscular monitoring
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Summary Deep neuromuscular blockade during certain surgical procedures may improve operating conditions. Sugammadex can be used to reverse deep neuromuscular blockade without waiting for spontaneous recovery. This randomised study compared recovery times from neuromuscular blockade induced by rocuronium 0.6 mg.kg −1 , using sugammadex 4 mg.kg −1 administered at 1–2 post‐tetanic count (deep blockade) or neostigmine 50 μg.kg −1 (plus atropine 10 μg.kg −1 ) administered at the re‐appearance of the second twitch of a train‐of‐four stimulation (moderate blockade), in patients undergoing laparoscopic surgery. The primary efficacy variable was the time from the start of sugammadex/neostigmine administration to recovery of the train‐of‐four ratio to 0.9. Patients receiving sugammadex recovered 3.4 times faster than patients receiving neostigmine (geometric mean (95% CI) recovery times of 2.4 (2.1–2.7) and 8.4 (7.2–9.8) min, respectively, p < 0.0001). Moreover, 94% (62/66) of sugammadex‐treated patients recovered within 5 min, vs 20% (13/65) of neostigmine‐treated patients, despite the difference in the depth of neuromuscular blockade at the time of administration of both drugs. The ability to provide deep neuromuscular blockade throughout the procedure but still permit reversal at the end of surgery may enable improved surgical access and an enhanced visual field.
Sugammadex
Neuromuscular monitoring
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Sugammadex
Neuromuscular Blocking Agents
Reversing
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Sugammadex
Neuromuscular monitoring
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Background: Residual neuromuscular blockade (NMB) is associated with increased risk of post-operative critical respiratory events. We compared incidence of residual NMB at tracheal extubation after reversal of rocuroniuminduced NMB with sugammadex versus neostigmine.
Methods: Adult patients of American Society of Anesthesiologists Class 1-3, scheduled to undergo open abdominal surgery were included. Patients were randomized to receive sugammadex 4.0 mg/kg at ≥1-2 posttetanic counts after last rocuronium dose, or neostigmine 50mg/kg + glycopyrrolate 10mg/kg, according to usual care practices at each institution. Neuromuscular function was assessed using TOF-Watch® SX. Anesthesiologists were blinded to the TOF-Watch recording, except to ask the TOF-Watch operator whether ≥1 PTC had been reached before administering reversal. Use of a peripheral nerve stimulator was permitted. Clinical criteria defined by the institution were used to determine when to perform extubation. Primary efficacy variable was incidence of residual NMB (train-of-four [TOF] ratio <0.9) at extubation. Safety parameters were assessed by a blinded safety assessor.
Results: The intent-to-treat group comprised 97 patients (sugammadex, n=51; neostigmine, n=46). Among patients with valid TOF data, a TOF ratio of ≥0.9 was reached at or before extubation in 48 of 50 (96.0%) sugammadex and 17 of 43 (39.5%) neostigmine patients (P<0.0001). One sugammadex (2.0%) and 15 neostigmine patients (34.9%) were extubated at TOF ratios ≤0.7. Median (95% CI) time from study drug administration to recovery to a TOF ratio ≥0.9 was 2.0 (1.8-2.5) minutes for sugammadex (n=49) versus 8.0 (3.8-16.5) minutes for neostigmine (n=18) (P<0.0001). Safety was comparable between groups, with no clinical evidence of recurrence of NMB.
Conclusions: Significantly more sugammadex-treated patients recovered to a TOF ratio ≥0.9 at extubation and did so significantly faster than neostigmine-treated patients. This study confirms that sugammadex is more effective than neostigmine in reducing potential for residual blockade in the absence of objective NMB monitoring.
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Background: Sugammadex is a new reversal agent for nondepolarizing neuromuscular blockade. We conducted the randomized clinical study to compare the recovery between sugammadex alone and combined use of sugammadex and neostigmine.
Methods: Forty adult patients were randomly allocated to Group S (n=20) or Group SN (n=20). General anesthesia was induced and maintained with propofol and remifentanil. The patients were intubated without neuromuscular blockers. After the stabilization of TOF Watch SX® acceleromyography as control, rocuronium 0.6 mg/kg was administered to patients in both groups. The patients in Group S received sugammadex 1.0 mg/kg and those in Group SN received sugammadex 0.5 mg/kg, neostigmine 0.04 mg/kg and atropine 0.02 mg/kg five minutes after rocuronium administration. The cost of reversal and recovery time were measured in both groups.
Results: We analyzed the data of 36 patients (n=18 in each group). The T1/control ratios were significantly higher in Group SN than in group S at 5, 10 and 15minutes after administration of reversal agents. The TOF ratios were significantly higher in Group SN than in group S at 10 and 15minutes after administration of reversal agents. The 90% recovery time of TOF ratio in Group SN was significantly shorter than that in Group S. The cost of reversal was significantly smaller in Group SN than in Group S.
Conclusions: By partially substituting sugammadex with neostigmine, we can attain faster recovery from rocuronium-induced profound neuromuscular blockade.
Sugammadex
Rocuronium Bromide
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No abstract available PMID: 33875335
Sugammadex
Reversing
Neuromuscular Blocking Agents
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Kvolik, S.; Rakipovic, A.; Mraovic, B.; Kristek, J.; Ikic, V.; Kristic, M. Author Information
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The use of neuromuscular blocking agents (NMBA) has grown due to the development of laparoscopic and minimally invasive procedures. Respiratory insufficiency, an elevated risk of aspiration, postoperative pulmonary complications, and subsequent reintubation are among the risks linked to the residual block. The normal clinical practice calls for the pharmacologic "reversal" of these agents with either sugammadex or neostigmine prior to extubation. The administration of neostigmine is linked to a number of potential complications. In response, anaesthesiologists have begun to prescribe sugammadex more frequently for treating residual block and reversing blockade with NMBA. This review article compares and assesses neostigmine and sugammadex thoroughly in order to determine the extent to which they work as agents to reverse neuromuscular blockade. The review's findings highlight sugammadex's considerable advantages - Sugammadex's ability to quickly and reliably achieve desired train-of-four (TOF) ratios - over neostigmine in reversing neuromuscular blockade in a variety of surgical settings. In contrast, neostigmine's limitations regarding efficacy and rate of reversal were consistently noted in all of the reviewed studies, despite the fact that it is still widely used due to its lower cost and extensive clinical experience. Sugammadex is a superior option for reversing neuromuscular blockade, but incorporating it into standard clinical practice necessitates carefully weighing its potential benefits and drawbacks. Sugammadex provides notable benefits over neostigmine in terms of speed, predictability, and safety.
Sugammadex
Neuromuscular Blocking Agents
Reversing
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s and Programme: EUROANAESTHESIA 2011: The European Anaesthesiology Congress: Paediatric Anaesthesia and Intensive Care
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