Article Notes
A fascinating historical article, both because of it's current relevance and the glimpse it provides of the exploration of a relatively new drug – along with tidbits regarding the safety of the technique:
"This is borne out by the fact that after many thousands of cases had been done, the first case of convulsions occurred. The intravenous Xylocaine had been increased to a very rapid rate and generalized convulsions ensued. For this case, all that was needed, was to stop the drip, supplement respiration with 100% oxygen and wait several minutes for the convulsion to subside. Thiopental sodium and succinylcholine chloride were at hand but not needed. However, it should be emphasized that this technique is not for the beginner."
See also the reply letter from Audra Webber and Melissa Kreso: Informed Consent for Sugammadex and Oral Contraceptives: Through the Looking Glass.
Human Love of Bells and Whistles
"Increasing the technological complexity of treatment appears to increase the significance of an illness and the appeal of an intervention. Furthermore, if hospitalization is required, additional distinction may be conferred. For instance, good evidence demonstrates that oral rehydration during acute diarrheal illness is at least as good as intravenous therapy. For most patients, metered-dose inhalers are as effective as nebulized bronchodilators, but inhalers are generally regarded as lesser treatments. The gadgetry of gizmos somehow provides cachet, and electrified intravenous pumps and nebulizer machines seem more substantive."
– Leff & Finucane, 2008
As the evidence-base increases and the cost falls, it will be indications #2 and #4 that carry our shift in practice to using sugammadex and its successors. We will recognise larger groups of patients for whom residual paralysis is detrimental (everyone?) while simultaneously appreciating better how common the problem truly is.
Evidence challenging, debunking or correcting long-held anesthesia dogma.
A narrative article describing the myths can be found here:
Neuromuscular myths: we need to do better!