Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2007
Randomized Controlled Trial Comparative StudySugammadex reversal of rocuronium-induced neuromuscular blockade: a comparison with neostigmine-glycopyrrolate and edrophonium-atropine.
Time to achieve full reversal (TOFR > 0.9) was significantly faster with sugammadex (107s ± 61) than neostigmine (1044 ±590s) or edrophonium (331s ± 27).
All sugammadex-reversed patients were completely reversed within 5 minutes, compared with no patients receiving neostigmine.
Reversal with sugammadex lead to less increase in heart-rate than when neostigmine-glycopyrrolate or edrophonium-atropine and almost total avoidance of the dry-mouth associated with the later (5% vs 85-95%)
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Anesthesia and analgesia · Mar 2007
EditorialSugammadex: an opportunity to change the practice of anesthesiology?
Miller enthusiastically states:
“Sugammadex is likely the most exciting drug in clinical neuromuscular pharmacology since the introduction of atracurium and vecuronium in the middle 1980s.”
...and hints at where benefits may begin:
“Will sugammadex’s increased effectiveness, in comparison to neostigmine, lessen the need for or use of monitoring neuromuscular function?”
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Anesthesia and analgesia · Mar 2007
Case ReportsA temporary decrease in twitch response during reversal of rocuronium-induced muscle relaxation with a small dose of sugammadex.
We present a case in which a temporary decrease in train-of-four (TOF) response was observed after reversal of muscle relaxation with a small dose (0.5 mg/kg) of sugammadex administered 42 min after 0.9 mg/kg of rocuronium. At the end of the operation, the TOF ratio was >0.9, and the patient woke normally, without signs of muscle weakness. We describe this temporary decrease in muscle response during muscle relaxation reversal as muscle relaxation rebound and hypothesize that it occurs when the dose of sugammadex is sufficient for complex formation with rocuronium in the central compartment, but insufficient for redistribution of rocuronium from peripheral to central compartments. ⋯ Sufficiently large doses of sugammadex eliminate the possibility for muscle relaxation rebound, which does not require dissociation of the sugammadex/ rocuronium complex.
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Anesthesia and analgesia · Mar 2007
Randomized Controlled Trial Multicenter StudyA randomized, dose-finding, phase II study of the selective relaxant binding drug, Sugammadex, capable of safely reversing profound rocuronium-induced neuromuscular block.
The reversal of a deep neuromuscular blockade remains a significant clinical problem. Sugammadex, a modified gamma-cyclodextrin, encapsulates steroidal neuromuscular blocking drugs, promoting their rapid dissociation from nicotinic receptors. Sugammadex is the first drug that acts as a selective relaxant binding agent. ⋯ Sugammadex was well tolerated and effective in rapidly reversing profound rocuronium-induced neuromuscular block. The mean time to recovery decreased with increasing doses. Profound rocuronium-induced neuromuscular block can be reversed successfully with sugammadex at doses >/=2 mg/kg.
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In healthy patients, the narrowest diameter of the subglottic upper airway is the width of the air-column at the level of the cricoid cartilage. This diameter governs the selection of the endotracheal tube size, as excessive tube diameter may damage the tracheal mucosa leading to postextubation stridor or subglottic stenosis. Unfortunately, selecting endotracheal tube size based on height, weight, or age does not reliably lead to the proper tube. The knowledge of airway diameter, especially using a bedside noninvasive tool, could therefore be helpful in anesthesia and intensive care. ⋯ In young healthy adults, ultrasonography appeared to be a reliable tool to assess the diameter of the subglottic upper airway.