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Reversal agents in anaesthesia and critical care.

Pani N, Dongare PA, Mishra RK - Indian J Anaesth (2015)

Bottom Line: Despite the advent of short and ultra-short acting drugs, an in-depth knowledge of the reversal agents used is a necessity for any anaesthesiologist.The controversy on the routine reversal of neuromuscular blockade still exists.The advent of newer reversal agents like sugammadex have made the use of steroidal neuromuscular blockers like rocuronium feasible in rapid sequence induction situations.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology and Critical Care, S.C.B Medical College, Cuttack, Odisha, India.

ABSTRACT
Despite the advent of short and ultra-short acting drugs, an in-depth knowledge of the reversal agents used is a necessity for any anaesthesiologist. Reversal agents are defined as any drug used to reverse the effects of anaesthetics, narcotics or potentially toxic agents. The controversy on the routine reversal of neuromuscular blockade still exists. The advent of newer reversal agents like sugammadex have made the use of steroidal neuromuscular blockers like rocuronium feasible in rapid sequence induction situations. We made a review of the older reversal agents and those still under investigation for drugs that are regularly used in our anaesthesia practice.

No MeSH data available.


Related in: MedlinePlus

Sugammadex encapsulating rocuronium
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Figure 2: Sugammadex encapsulating rocuronium

Mentions: Development of this cyclodextrin is said to be the first pharmacological breakthrough in the past 60 years. It was discovered by Anton ‘Ton’ Bom a pharmaceutical chemist and presented in the 7th International Neuromuscular Meeting in Belfast.[8] Sugammadex (modified γ-cyclodextrin) [Figure 1] is a selective relaxant binding agent (su refers to sugar, whereas gammadex emphasizes to the structural molecule gamma-cyclodextrin). Sugammadex complexes with steroidal NMBAs in a 1:1 ratio (rocuronium > vecuronium ≫ pancuronium) by forming a guest-host complex, which helps in rapid removal of free rocuronium molecules from plasma. It completely encapsulates the molecule of steroidal NMBAs and is excreted via the kidney unchanged [Figure 2].[9] The dose of sugammadex is dependent on the dose of muscle relaxant used. The recommended doses are between 2 and 16 mg/kg body weight.[4] Studies have found the incidence of inadequate reversal with 0.5 mg/kg.[10] One case report has reported recurarisation in an obese individual with a dose of 1.74 mg/kg.[11] The use of this molecule is also very important in cardiac surgery[12] as the arrhythmogenic potential of standard neostigmine and glycopyrrolate limits their use. Sugammadex can also be used as an acute therapeutic option in the event of an allergic reaction against rocuronium.[13] Use of sugammadex makes the use of rocuronium possible in patients with neuromuscular disorders.[14] Controversy on the dose to be administered in morbidly obese patients still continues. The present recommendation is to administer sugammadex based on the actual body weight, but one study has compared the use of doses based on lean body weight, lean body weight +20% and lean body weight +40% and found the administration of lean body weight +40% to be better.[15] The disadvantage is that it cannot reverse the action of benzylisoquinolinium compounds.[4]


Reversal agents in anaesthesia and critical care.

Pani N, Dongare PA, Mishra RK - Indian J Anaesth (2015)

Sugammadex encapsulating rocuronium
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4645356&req=5

Figure 2: Sugammadex encapsulating rocuronium
Mentions: Development of this cyclodextrin is said to be the first pharmacological breakthrough in the past 60 years. It was discovered by Anton ‘Ton’ Bom a pharmaceutical chemist and presented in the 7th International Neuromuscular Meeting in Belfast.[8] Sugammadex (modified γ-cyclodextrin) [Figure 1] is a selective relaxant binding agent (su refers to sugar, whereas gammadex emphasizes to the structural molecule gamma-cyclodextrin). Sugammadex complexes with steroidal NMBAs in a 1:1 ratio (rocuronium > vecuronium ≫ pancuronium) by forming a guest-host complex, which helps in rapid removal of free rocuronium molecules from plasma. It completely encapsulates the molecule of steroidal NMBAs and is excreted via the kidney unchanged [Figure 2].[9] The dose of sugammadex is dependent on the dose of muscle relaxant used. The recommended doses are between 2 and 16 mg/kg body weight.[4] Studies have found the incidence of inadequate reversal with 0.5 mg/kg.[10] One case report has reported recurarisation in an obese individual with a dose of 1.74 mg/kg.[11] The use of this molecule is also very important in cardiac surgery[12] as the arrhythmogenic potential of standard neostigmine and glycopyrrolate limits their use. Sugammadex can also be used as an acute therapeutic option in the event of an allergic reaction against rocuronium.[13] Use of sugammadex makes the use of rocuronium possible in patients with neuromuscular disorders.[14] Controversy on the dose to be administered in morbidly obese patients still continues. The present recommendation is to administer sugammadex based on the actual body weight, but one study has compared the use of doses based on lean body weight, lean body weight +20% and lean body weight +40% and found the administration of lean body weight +40% to be better.[15] The disadvantage is that it cannot reverse the action of benzylisoquinolinium compounds.[4]

Bottom Line: Despite the advent of short and ultra-short acting drugs, an in-depth knowledge of the reversal agents used is a necessity for any anaesthesiologist.The controversy on the routine reversal of neuromuscular blockade still exists.The advent of newer reversal agents like sugammadex have made the use of steroidal neuromuscular blockers like rocuronium feasible in rapid sequence induction situations.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology and Critical Care, S.C.B Medical College, Cuttack, Odisha, India.

ABSTRACT
Despite the advent of short and ultra-short acting drugs, an in-depth knowledge of the reversal agents used is a necessity for any anaesthesiologist. Reversal agents are defined as any drug used to reverse the effects of anaesthetics, narcotics or potentially toxic agents. The controversy on the routine reversal of neuromuscular blockade still exists. The advent of newer reversal agents like sugammadex have made the use of steroidal neuromuscular blockers like rocuronium feasible in rapid sequence induction situations. We made a review of the older reversal agents and those still under investigation for drugs that are regularly used in our anaesthesia practice.

No MeSH data available.


Related in: MedlinePlus