[Sugammadex: something new to improve patient safety or simply a gadget?].
The launch on the market of a new compound is always an important event for a specialty, particularly when the mechanism of action is completely new. It is the case with sugammadex, a cyclodextrin able to encapsulate specifically and only nondepolarizing steroidal muscles relaxant, rocuronium or vecuronium. The clinical trials which have been performed for sugammadex approval have demonstrated promising results. Sugammadex is able to rapidly reverse (2-5 min) different levels of neuromuscular blockade: moderate (e.g., T2 recovery), deep (e.g., PTC 1-2 recovery) and also few minutes (3-15) after rocuronium administration. Thus, the sugammadex's onset time is about 10 times more rapid than neostigmine without the need of concomitantly atropine administration. Sugammadex has only been tested in small sample size of patients. Therefore, the exact place in the anesthetic practice, the potential indications, the safety profile on a large-scale, thus remain to determine. In particular, how it will modify our current practices characterized to date by 1) under-use of neuromuscular monitoring, 2) a marginal practice of reversal and 3) a wide use of benzylisoquinolines : atracurium and cis-atracurium? Finally, what will be the medical strategies to justify an additional cost when compared to neostigmine?
Plaud
B
B
Service d'anesthésie, réanimation chirurgicale, Samu94 - Smur; Université Paris XII et Groupe Hospitalier et Universitaire Albert Chenevier - Henri Mondor, 51, avenue du Maréchal de Lattre de Tassigny, 94010 Créteil cedex, France. benoit.plaud@hmn.aphp.fr
D000732:Androstanols / Q000009:adverse effects / Q000037:antagonists & inhibitors; D000762:Anesthesia Recovery Period; D001279:Atracurium / Q000009:adverse effects; D003362:Cost-Benefit Analysis; D017277:Drug Approval; D004568:Electrodiagnosis; D005602:France; D006801:Humans; D008991:Monitoring, Physiologic; D009126:Muscle Relaxation / Q000187:drug effects; D009388:Neostigmine / Q000627:therapeutic use; D019148:Neuromuscular Blockade / Q000009:adverse effects*; D003473:Neuromuscular Nondepolarizing Agents / Q000009:adverse effects / Q000037:antagonists & inhibitors* / Q000737:chemistry / Q000494:pharmacology; D011183:Postoperative Complications / Q000139:chemically induced / Q000175:diagnosis / Q000188:drug therapy*; D012133:Respiratory Paralysis / Q000139:chemically induced / Q000175:diagnosis / Q000188:drug therapy*; D000077123:Rocuronium; D000077122:Sugammadex; D014481:United States; D014673:Vecuronium Bromide / Q000009:adverse effects / Q000037:antagonists & inhibitors; D047408:gamma-Cyclodextrins / Q000008:administration & dosage / Q000191:economics / Q000494:pharmacology* / Q000627:therapeutic use*
D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D047408:gamma-Cyclodextrins; D001279:Atracurium; D000077122:Sugammadex; D009388:Neostigmine; D014673:Vecuronium Bromide; D000077123:Rocuronium