title: Comparison of Effects of Separate and Combined Sugammadex and Lipid Emulsion Administration on Hemodynamic Parameters and Survival in a Rat Model of Verapamil Toxicity.
abstract: BACKGROUND
  Toxicity of calcium channel blockers leads to high patient mortality and there is no effective antidote. The benefit of using 20% lipid emulsion and sugammadex has been reported. The present study measured the effect of sugammadex and 20% lipid emulsion on hemodynamics and survival in a rat model of verapamil toxicity.
  
  
  METHODS
  In this single-blinded randomized control study, rats were separated into 4 groups of 7 rats each: Sugammadex (S), Sugammadex plus 20% lipid emulsion (SL), 20% lipid emulsion (L), and control (C). Heart rates and mean arterial pressures were monitored and noted each minute until death.
  
  
  RESULTS
  Average time to death was 21.0±9.57 minutes for group C, 35.57±10.61 minutes for group S, 37.14±16.6 minutes for group L and 49.86±27.56 minutes for group SL. Time to death was significantly longer in other groups than in the control group (p<0.05).
  
  
  CONCLUSIONS
  Verapamil overdose is has a comparatively high mortality rate and there is no effective antidote. Treatment generally involves gastric decontamination and symptomatic treatment to counteract the drug's negative effects. In animal studies sugammadex and lipid emulsion had a positive effect on survival in patients with calcium channel blocker toxicity. Sugammadex and intralipid increased survival in a rat model of verapamil toxicity. The combination of both drugs may decrease cardiotoxicity. Sugammadex alone or combined with 20% lipid emulsion reduce the need for inotropic agents. The mechanism requires clarification with larger studies.
authors.affiliation: Department of Anesthesiology and Reanimation, Maltepe University Faculty of Medicine, Istanbul, Turkey.
authors.forename: Serkan
authors.initials: S
authors.lastname: Tulgar
authors.affiliation: Department of Anesthesiology and Reanimation, Dr. Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey.
authors.forename: Halil Cihan
authors.initials: HC
authors.lastname: Kose
authors.affiliation: Department of General Surgery, Bitlis State Hospital, Bitlis, Turkey.
authors.forename: Isılay
authors.initials: I
authors.lastname: Demir Piroglu
authors.affiliation: Department of Emergency Medicine, Ankara Numune Education and Research Hospital, Ankara, Turkey.
authors.forename: Evvah
authors.initials: E
authors.lastname: Karakilic
authors.affiliation: Department of Anesthesiology and Reanimation, Gumushane State Hospital, Gumushane, Turkey.
authors.forename: Nagihan Gozde
authors.initials: NG
authors.lastname: Ates
authors.affiliation: Department of Emergency Medicine, Sultanbeyli State Hospital, Istanbul, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Demir
authors.affiliation: Department of Anesthesiology and Reanimation, Karakocan State Hospital, Elazig, Turkey.
authors.forename: Ruken
authors.initials: R
authors.lastname: Gergerli
authors.affiliation: Department of Anesthesiology and Reanimation, Dr. Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey.
authors.forename: Selin
authors.initials: S
authors.lastname: Guven
authors.affiliation: Department of Anesthesiology and Reanimation, Bitlis State Hospital, Bitlis, Turkey.
authors.forename: Mustafa Devrim
authors.initials: MD
authors.lastname: Piroglu
mesh_terms: D000818:Animals; D001794:Blood Pressure / Q000187:drug effects; D004195:Disease Models, Animal; D004655:Emulsions / Q000008:administration & dosage / Q000494:pharmacology*; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D053208:Kaplan-Meier Estimate; D008055:Lipids / Q000494:pharmacology*; D000077122:Sugammadex; D014700:Verapamil / Q000494:pharmacology* / Q000633:toxicity*; D047408:gamma-Cyclodextrins / Q000494:pharmacology*
chemical_list: D004655:Emulsions; D008055:Lipids; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D014700:Verapamil