RESUMO
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?
Assuntos
Bloqueio Neuromuscular/efeitos adversos , Fármacos Neuromusculares não Despolarizantes/antagonistas & inibidores , Complicações Pós-Operatórias/tratamento farmacológico , Paralisia Respiratória/tratamento farmacológico , gama-Ciclodextrinas/farmacologia , gama-Ciclodextrinas/uso terapêutico , Androstanóis/efeitos adversos , Androstanóis/antagonistas & inibidores , Período de Recuperação da Anestesia , Atracúrio/efeitos adversos , Análise Custo-Benefício , Aprovação de Drogas , Eletrodiagnóstico , França , Humanos , Monitorização Fisiológica , Relaxamento Muscular/efeitos dos fármacos , Neostigmina/uso terapêutico , Fármacos Neuromusculares não Despolarizantes/efeitos adversos , Fármacos Neuromusculares não Despolarizantes/química , Fármacos Neuromusculares não Despolarizantes/farmacologia , Complicações Pós-Operatórias/induzido quimicamente , Complicações Pós-Operatórias/diagnóstico , Paralisia Respiratória/induzido quimicamente , Paralisia Respiratória/diagnóstico , Rocurônio , Sugammadex , Estados Unidos , Brometo de Vecurônio/efeitos adversos , Brometo de Vecurônio/antagonistas & inibidores , gama-Ciclodextrinas/administração & dosagem , gama-Ciclodextrinas/economiaRESUMO
In pediatric practice, complications due to the laryngeal mask airway (LMA) have been studied with size 2 LMA, but not with size 1 LMA. We, therefore, compared prospectively the complications induced by LMA size 1 and 2 in 141 children aged 21 days to 11 yr. Intraoperative and lowest SpO2 values after removal of LMA were recorded. The following complications were recorded: cough, laryngospasm, bronchospasm, apnea, and airway obstruction. In 14 patients in the size 1 LMA group and 26 patients in the size 2 LMA group, pharyngolaryngeal structures were checked with fiberoptic examination. The number of attempts, complications, intraoperative SpO2, and lowest SpO2 values were similar when using size 1 and size 2 LMA. Fiberoptic examination of size 1 LMA showed a high incidence of impinging of the epiglottis in the LMA bars without airway obstruction. In conclusion, there was no difference in the complication rate between the two pediatric sizes of LMA when used in pediatric patients.