Recurarization with magnesium sulfate administered after two minutes sugammadex reversal: A randomized, double-blind, controlled trial.

STUDY OBJECTIVE: The current study tested the hypothesis that magnesium sulfate after reversal with sugammadex causes recurarization. DESIGN: A single-center, prospective, randomized, double-blind, controlled trial. SETTING: Terciary care hospital in Rio de Janeiro, Brazil. PATIENTS: Included 60 patients undergoing for elective otolaryngological surgery. INTERVENTIONS: All patients received total intravenous anesthesia and a single dose of rocuronium (0.6 mg/kg). In 30 patients, the neuromuscular blockade was reversed with sugammadex (4 mg/kg) at the reappearance of one or two posttetanic counts (deep-blockade series). In 30 other patients, sugammadex (2 mg/kg) was administered at the reappearance of the second twitch of the train-of-four (moderate-blockade series). After the normalized train-of-four ratio recovered to ≥0.9, the patients in each series were randomized to receive intravenous magnesium sulfate (60 mg/kg) or placebo for 10 min. Neuromuscular function was measured by acceleromyography. MEASUREMENTS: The primary outcome was the number of patients who exhibited recurarization (normalized train-of-four ratio < 0.9). The secondary outcome was rescue with an additional dose of sugammadex after 60 min. MAIN RESULTS: In the deep-blockade series, a normalized train-of-four ratio < 0.9 occurred in 9/14 (64%) patients receiving magnesium sulfate and 1/14 (7%) receiving placebo, RR 9.0 (95% CI: 62-1.30), and (p = 0.002), with four rescues with sugammadex. In the moderate-blockade series, neuromuscular blockade recurred in 11/15 (73%) patients receiving magnesium sulfate and in 0/14 (0%) receiving placebo (p < 0.001), with two rescues. The absolute differences in recurarization were 57% and 73% in the deep-blockade and moderate-blockade, respectively. CONCLUSIONS: Single-dose magnesium sulfate led to a normalized train-of-four ratio < 0.9, 2 min after recovery from rocuronium-induced deep and moderate neuromuscular blockade using sugammadex. Additional sugammadex reversed prolonged recurarization.

Comparison of the effects of sugammadex and neostigmine on postoperative nausea and vomiting.

BACKGROUND AND OBJECTIVES: The aim of our study is to compare the effects of sugammadex and neostigmine, used for neuromuscular blockage antagonism, on postoperative nausea and vomiting (PONV). METHODS: Our study was completed with 98 ASA I-II risk patients undergoing endotracheal intubation under general anesthesia. At the end of the surgery patients were randomly divided into two groups given 2mgkg-1 sugammadex (Group S) or 50µgkg-1 neostigmine plus 0.2mgkg-1 atropine (Group N). Monitoring and recording times were set as 1 hour postoperative and from 1-6, 6-12, and 12-24hours. The anti-emetic amounts administered were recorded. RESULTS: In the first hour postoperative 13 patients in Group N (27%) and 4 in Group S (8%) were observed to have nausea and/or vomiting and the difference was statistically significant (p=0.0016). During the 24 hours of monitoring there was no significant difference in the incidence and severity of PONV (p>0.05), however the number of patients given ondansetron for PONV treatment in Group N was statistically significantly higher than the number in Group S (16 in Group N, 6 in Group S, p<0.011). CONCLUSIONS: At the end of our study comparing neostigmine with sugammadex for neuromuscular blockage antagonism, we found use of sugammadex had lower incidence of PONV in the postoperative 1st hour and less anti-emetic use in 24 hours of monitoring.

Reversión o no del bloqueo neuromuscular posanestésico / Reversion or not of the blockade neuromuscular posanestésico

Introducción: los bloqueantes neuromusculares y su reversión se utilizan de forma cotidiana en la práctica anestesiológica. Sin embargo, la parálisis muscular residual producida por dichas drogas debido a la reversión incompleta del fármaco, pueden producir complicaciones que pueden llegar a ser fatales. Objetivo: realizar una actualización sobre, si es conveniente o no, revertir el bloqueo neuromuscular.Desarrollo: la reversión del bloqueo neuromuscular por drogas anticoli­nesterásicas es dependiente de la labilidad de la acetilcolina para liberar los receptores ocupados por agentes bloqueantes neuromusculares no despolarizantes. El sugammadex, es una ciclodextrina tipo gamma modificada, que se diseñó para revertir el bloqueo neuromuscular profundo inducido por rocuronio. Su mecanismo de acción se produce por la alta afinidad y gran selectividad para encapsular la molécula de rocuronio. Una vez que se une al bloqueante neuromuscular ya no puede producir efecto. En muchas ocasiones, se revierten estos fármacos, sin tener en cuenta la respuesta individual, ni las interacciones farmacológicas, ni las dosis administradas y su frecuencia, ni si tienen efectos acumulativos, por sólo citar algunos. Conclusiones: el bloqueo neuromuscular y su recuperación ocurre en cada paciente individualmente tras la administración de agentes bloqueadores competitivos, donde la variación individual en la farmacología de estas drogas, no permiten predecir con exactitud sus efectos(AU)

Introduction: the bloqueantes neuromusculares and their reversion are used in a daily way in the practical anestesiológica. However, the residual muscular paralysis taken place by this drugs due to the incomplete reversion of the fármaco, complications that can end up being fatal can take place. Objective: to carry out an upgrade on, if it is convenient or not, to revert the blockade neuromuscular. Development: the reversion of the blockade neuromuscular for drugs anticoli­nesterásicas is dependent of the labilidad of the acetilcolina to liberate the receivers occupied by agents bloqueantes neuromusculares non despolarizantes. The sugammadex, is a ciclodextrina type modified gamma that was designed to revert the blockade deep neuromuscular induced by rocuronio. Their action mechanism takes place for the high likeness and great selectivity to encapsulate the rocuronio molecule. Once he/she unites to the bloqueante neuromuscular it can no longer produce effect. In many occasions, these fármacos is reverted, without keeping in mind the individual answer, neither the pharmacological interactions, neither the administered doses and their frequency, neither if they have accumulative effects, for only to mention some. Conclusions: the blockade neuromuscular and their recovery happens individually in each patient after the administration of competitive blocking agents, where the individual variation in the pharmacology of these drugs, they don't allow to predict with accuracy its effects(AU)

Use of sugammadex on burn patients: descriptive study / Uso de sugamadex no paciente queimado: estudo descritivo / Utilización del sugammadex en el paciente quemado: estudio descriptivo

A burn patient is a challenge for any anesthesiologist, undergoing several surgeries during admission, and requiring general anesthesia and muscle relaxation most of the times. The victim may have respiratory system impairment and a response to muscle relaxants that differs from the healthy patient, thus proper monitoring and reversal is crucial. We analyzed sugammadex effectiveness and safety in this population.

O paciente queimado representa um desafio para o anestesiologista, pois se submete a várias intervenções cirúrgicas durante sua hospitalização e necessita de anestesia geral e relaxamento muscular na maior parte delas. Apresenta sistema respiratório comprometido e uma resposta aos relaxantes musculares que difere do paciente sadio; portanto, um monitoramento correto e reversão tornam-se imprescindíveis. Avaliamos a eficácia e segurança do sugamadex nessa população.

El paciente quemado supone un reto para el anestesista, pues se somete a varias intervenciones quirúrgicas durante su ingreso, requiriendo anestesia general y relajación muscular en la mayor parte de ellas. Presentan un sistema respiratorio comprometido y una respuesta a los relajantes musculares que difiere de la del paciente sano, por lo que se hace imprescindible una correcta monitorización y reversión. Valoramos la efectividad y seguridad del sugammadex en esta población.

Use of sugammadex on burn patients: descriptive study.

OBJECTIVES: A burn patient is a challenge for any anesthesiologist, undergoing several surgeries during admission, and requiring general anesthesia and muscle relaxation most of the times. The victim may have respiratory system impairment and a response to muscle relaxants that differs from the healthy patient, thus proper monitoring and reversal is crucial. We analyzed sugammadex effectiveness and safety in this population. MATERIALS AND METHODS: It was a prospectively descriptive study, including 4 patients, and all of them were considered major burn patients, who underwent escharotomy with general anesthesia and neuromuscular relaxation. The main variable was the time for recovery of a TOF higher than 0.9 after the administration of sugammadex before extubation. RESULTS: Mean time of recovery from a TOF ratio higher than 0.9 following the administration of Sugammadex was of 4.95min 95% CI (3.25-6.64, p=.53). CONCLUSIONS: The reversion of neuromuscular relaxation with sugammadex appears to be effective and safe in the burn patient. More analytical, comparative studies of larger populations would be necessary to confirm these data.