A novel approach to reversal of neuromuscular blockade.
Postoperative residual curarization is still a problem of the modern anesthesia. Neostigmine is not the safest drug that allows a safe decurarization, especially when neuromuscular transmission monitoring is not used. Sugammadex is a A-cyclodextrin designed to encapsulate rocuronium bromide, providing a rapid reversal of neuromuscular blockade. It has not cardiovascular, respiratory and cholinergic effects. It has been used in renally impaired patients with no neuromuscular blockade recurrence. Sugammadex reverses either a shallow or a deep neuromuscular block. Volatile agents such as sevoflurane seems not to influence the sugammadex ability to reverse the rocuronium neuromuscular blockade. There is no difference in the sugammadex pharmacokinetic in children and adults. Sugammadex would be able to have a role in the future in reversing a non depolarizing steroidal neuromuscular block.
Department of Anesthesia and Intensive Care Medicine, S. Maria della Misericordia University Hospital, University of Udine, Udine, Italy. giorgio.dellarocca@uniud.it
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Della Rocca
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Pompei
D000293:Adolescent; D000328:Adult; D000732:Androstanols / Q000037:antagonists & inhibitors; D002648:Child; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D055191:Delayed Emergence from Anesthesia / Q000188:drug therapy*; D006801:Humans; D008738:Methyl Ethers / Q000493:pharmacokinetics; D009388:Neostigmine / Q000627:therapeutic use; D019148:Neuromuscular Blockade / Q000009:adverse effects* / Q000379:methods; D003473:Neuromuscular Nondepolarizing Agents / Q000009:adverse effects / Q000037:antagonists & inhibitors / Q000494:pharmacology; D010243:Paralysis / Q000139:chemically induced / Q000188:drug therapy; D000077123:Rocuronium; D000077149:Sevoflurane; D000077122:Sugammadex; D047408:gamma-Cyclodextrins / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*
D000732:Androstanols; D002800:Cholinesterase Inhibitors; D008738:Methyl Ethers; D003473:Neuromuscular Nondepolarizing Agents; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D000077149:Sevoflurane; D009388:Neostigmine; D000077123:Rocuronium