Sugammadex: An Update

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The purpose of this update is to provide recent knowledge and debates regarding the use of sugammadex in the fields of anesthesia and critical care. The review is not intended to provide a comprehensive description of sugammadex and its clinical use.

1. Shields M, Giovannelli M, Mirakhur K, et al. Org 25969 (sugammadex), a selective relaxant binding agent for antagonism of prolongedrocuronium-induced neuromuscular block. Br J Anaesth. 2006;96:36-43.

2. Fortier LP, McKeen D, Turner K, de Medicis E, et al. The RECITE Study: A Canadian Prospective, Multicenter Study of the Incidence and Severity of Residual Neuromuscular Blockade. AnesthAnalg. 2015;121:366-72.

3. Brueckmann B, Sasaki N, Grobara P, et al. Effects of sugammadex on incidence of postoperative residual neuromuscular blockade: a randomized, controlled study. Br J Anaesth. 2015;115:743-51.

4. Ledowski T, Ong JS, FlettT. Neuromuscular Monitoring, Muscle Relaxant Use, and Reversal at a Tertiary Teaching Hospital 2.5 Years after Introduction of Sugammadex: Changes in Opinions and Clinical Practice. Anesthesiol Res Pract. 2015;2015:367937.

5. Partownavid P, Romito BT, Ching W, Berry AA, Barkulis CT, Nguyen KP, JahrJS. Sugammadex: A Comprehensive Review of the Published Human Science, Including Renal Studies. Am J Ther.2015;22:298-317.

6. Benigni A, Maffioletti M, Spotti A, Benigni AM, Locatelli BG, Sonzogni V. Efficacy and safety of a sugammadex dose of 4 mg/ kg in early reversal of a deep neuromuscular block rocuroniuminduced in infants and children: a case series. Eur J Anaesthesiol. 2013;30:161-2.

7. Plaud B, Meretoja O, Hofmockel R, et al. Reversal of rocuroniuminduced neuromuscular blockade with sugammadex in pediatric and adult surgical patients. Anesthesiology. 2009;110:284-94.

8. Meretoja OA. Neuromuscular block and current treatment strategies for its reversal in children. Paediatr Anaesth. 2010;20:591-604.

9. Staikou C, Stamelos M, Stavroulakis E. Impact of anaesthetic drugs and adjuvants on ECG markers of torsadogenicity. Br J Anaesth. 2014;112:217-30. 10 Tsur A, Kalansky A. Hypersensitivity associated with sugammadex administration: a systematic review.Anaesthesia. 2014;69:1251-7.

11. McDonnell NJ, Pavy TJ, Green LK, Platt PR. Sugammadex in the management of rocuronium-induced anaphylaxis. Br J Anaesth. 2011;106:199-201.

12. Plaud B. A new option for the treatment of anaphylaxis linked to steroidal neuromuscular blockers: How much value should we grant to case reports? Can J Anaesth. 2014;61:511-8.

13. Cammu G, Van Vlem B, van den Heuvel M, et al. Dialysability of sugammadex and its complex with rocuronium in intensive care patients with severe renal impairment. Br J Anaesth. 2012;109:382-90.

14. Rahe-Meyer N, Fennema H, Schulman S, et al. Effect of reversal of neuromuscular blockade with sugammadex versus usual care on bleeding risk in a randomized study of surgical patients. Anesthesiology.2014;121:969-77.

15. WATAG (Western Australian Therapeutic Advisory Group): Sugammadex Guidelines - July 2013 (online source) -

16. Veelo DP, Gisbertz SS, Hannivoort RA, et al. The effect of ondemand vs deep neuromuscular relaxation on rating of surgical and anaesthesiologic conditions in patients undergoing thoracolaparoscopicesophagectomy (DEPTH trial): study protocol for a randomized controlled trial. Trials. 2015;16:331.

17. Evron S, Yakobashvili S, Rigini N, Ezri T. Successful Reversal with Sugammadex of Deep Neuromuscular Block Caused by Rocuronium and Magnesium Sulfate in a Patient with H.E.L.P Syndrome. Acta Medica Marisiensis. 2012;58:7.

18. Pühringer FK, Kristen P, Rex C. Sugammadex reversal of rocuronium-induced neuromuscular block in caesarean section patients: a series of seven cases. Br J Anaesth. 2010;105:657-60.

19. Williamson RM, Mallaiah S, Barclay P. Rocuronium and sugammadex for rapid sequence induction of obstetric general anaesthesia. Acta Anaesthesiol Scand. 2011;55:694-9.

20. Gaszynski T, Szewczyk T, Gaszynski W. Randomized comparison of sugammadex and neostigmine for reversal of rocuroniuminduced muscle relaxation in morbidly obese undergoing general anaesthesia. Br J Anaesth. 2012;108:236-9.

21. Van Lancker P, Dillemans B, Bogaert T, Mulier JP, De Kock M, Haspeslagh M. Ideal versus corrected body weight for dosage of sugammadex in morbidly obese patients.Anaesthesia. 2011;66:721-5.

22. Suzuki T, Masaki G, Ogawa S. Neostigmine-induced reversal of vecuronium in normal weight, overweight and obese female patients. Br J Anaesth. 2006;97:160-3.

23. Illman HL, Laurila P, Antila H, Meretoja OA, Alahuhta S, Olkkola KT. The duration of residual neuromuscular block after administration of neostigmine or sugammadex at two visible twitches during train-of-four monitoring. Anesth Analg. 2011;112:63-8.

24. Ezri T, Evron S, Petrov I, Schachter P, Berlovitz P, Shimonov M. Residual curarization and postoperative respiratory complications following laparoscopic sleeve gastrectomy. The effect of reversal agents: sugammadex vs. neostigmine. J Crit Care Med. 2015;1:61-67.

25. El-Orbany M, Connolly LA. Rapid sequence induction and intubation: current controversy. Anesth Analg. 2010;110:1318-25.

26. Taha SK, El-Khatib MF, Baraka AS, et al. Effect of suxamethonium vs rocuronium on onset of oxygen desaturation during apnoea following rapid sequence induction. Anaesthesia. 2010;65:358-61.

27. Donati F. Neuromuscular blocking agents. In Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC, Ortega R: Clinical anesthesia, 7th ed., chapter 20, page 533, Wolters Kluwer, Philadelphia 2013.

28. Sorensen M.K, Bretlau C, Gatke MR, Sorensen AM, Rasmussen LS. Rapid sequence induction and intubation with rocuroniumsugammadex compared with succinylcholine: A randomized trial. Br J Anaesth. 2012;108:682-9.

29. Mendonca C. Sugammadex to rescue a ‘can’t ventilate’ scenario in an anticipated difficult intubation: is it the answer? Anaesthesia. 2013;68:795-9.

30. Bisschops MMA, Holleman C, Huitink JM. Can sugammadex save a patient in a simulated ‘cannot intubate, cannot ventilate’ situation? Anaesthesia. 2010;65:936-41.

31. Curtis R, Lomax S, Patel B. Use of sugammadex in a ‘can’t intubate, can’t ventilate’ situation. Br J Anaesth. 2012;108:612-4.

32. Kyle BC, Gaylard D, Riley RH. A persistent ‘can’t intubate, can’t oxygenate’ crisis despite rocuronium reversal with sugammadex. Anaesth Intensive Care. 2012;40:344-6.

33. Karalapillai D, Kaufman M, Weinberg L. Sugammadex. Crit Care Resusc. 2013;15:57-62.

34. Ortega-Gonzalez M. Anaesthesia for trauma patients. S Afr Fam Pract. 2012;54(Suppl 1):S2-S6.

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