title: Can sugammadex save a patient in a simulated 'cannot intubate, cannot ventilate' situation?
abstract: Recent studies have shown that the use of high dose rocuronium followed by sugammadex provides a faster time to recovery from neuromuscular blockade following rapid sequence induction than suxamethonium. In a manikin-based 'cannot intubate, cannot ventilate' simulation, we studied the total time taken for anaesthetic teams to prepare and administer sugammadex from the time of their initial decision to use the drug. The mean (SD) total time to administration of sugammadex was 6.7 (1.5) min, following which a further 2.2 min (giving a total 8.9 min) should be allowed to achieve a train-of-four ratio of 0.9. Four (22%) teams gave the correct dose, 10 (56%) teams gave a dose that was lower than recommended, four (22%) teams gave a dose that was higher than recommended, six (33%) teams administered sugammadex in a single dose, and 12 (67%) teams gave multiple doses. Our simulation highlights that sugammadex might not have saved this patient in a 'cannot intubate, cannot ventilate' situation, and that difficulties and delays were encountered when identifying, preparing and administering the correct drug dose.
authors.affiliation: Department of Anesthesiology, VU University Medical Centre, Amsterdam, Netherlands.
authors.forename: M M A
authors.initials: MM
authors.lastname: Bisschops
authors.forename: C
authors.initials: C
authors.lastname: Holleman
authors.forename: J M
authors.initials: JM
authors.lastname: Huitink
mesh_terms: D000732:Androstanols / Q000037:antagonists & inhibitors* / Q000494:pharmacology; D000075202:Contraindications; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D006801:Humans; D007442:Intubation, Intratracheal; D008348:Manikins; D019148:Neuromuscular Blockade; D009469:Neuromuscular Junction / Q000187:drug effects*; D003473:Neuromuscular Nondepolarizing Agents / Q000037:antagonists & inhibitors* / Q000494:pharmacology; D012121:Respiration, Artificial; D000077123:Rocuronium; D000077122:Sugammadex; D047408:gamma-Cyclodextrins / Q000008:administration & dosage / Q000494:pharmacology*
chemical_list: D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D000077123:Rocuronium