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Emerging considerations in the reversal of neuromuscular blockade and residual block
1,Mayo Clinic College of Medicine
*Corresponding Author(s): WAYNE T. NICHOLSON E-mail: nicholson.wayne@mayo.edu
Incomplete recovery following reversal of neuromuscular blockade can present as a clinical problem in surgical patients. Emerging pharmacologic solutions may prevent such adverse outcomes in the future. We briefly review two methods of pharmacologic reversal of neuromuscular blockade. Both methods of reversal are effective. However the early studies of the new compound, sugammadex has been shown to achieve a more rapid, stable reversal of steroidal based neuromus-cular blocking agents compared to neostigmine. Due to the novel mechanism of action of this agent, sugammadex has been demonstrated to be effective even when administered during profound neuromuscular block, without evidence of recurarization.
sugammadex, Org 25969, cyclodextrin, rocuronium, cholineste-rase inhibitor
WAYNE T. NICHOLSON,JURAJ SPRUNG,CHRISTOPHER J. JANKOWSKI. Emerging considerations in the reversal of neuromuscular blockade and residual block. Signa Vitae. 2008. 3(1);35-38.
1. Bevan DR. Monitoring and reversal of neuromuscular block. Am J Health Syst Pharm 1999;56:S10-3.
2. Debaene B, Plaud B, Dilly MP, Donati F. Residual paralysis in the PACU after a single intubating dose of nondepolarizing muscle relaxant with an intermediate duration of action. Anesthesiology 2003;98:1042-8.
3. Fawcett WJ, Stone JP. Recurarization in the recovery room following the use of magnesium sulphate. Br J Anaesth 2003;91:435-8.
4. Bruckner J, Thomas KC Jr, Bikhazi GB, Foldes FF. Neuromuscular drug interactions of clinical importance. Anesth Analg 1980;59:678-82.
5. Burkett L, Bikhazi GB, Thomas KC Jr, Rosenthal DA, Wirta MG, Foldes FF. Mutual potentiation of the neuromuscular effects of antibiotics and relaxants. Anesth Analg 1979;58:107-15.
6. Lee C, de Silva AJ. Interaction of neuromuscular blocking effects of neomycin and polymyxin B. Anesthesiology 1979;50:218-20.
7. Paradelis AG, Triantaphyllidis C, Giala MM. Neuromuscular blocking activity of aminoglycoside antibiotics. Methods Find Exp Clin Phar-macol 1980;2:45-51.
8. Rutten JM, Booij LH, Rutten CL, Crul JF. The comparative neuromuscular blocking effects of some aminoglycoside antibiotics. Acta Anaesthesiol Belg 1980;31:293-306.
9. Del Pozo E, Baeyens JM. Effects of calcium channel blockers on neuromuscular blockade induced by aminoglycoside antibiotics. Eur J Pharmacol 1986;128:49-54.
10. Beaussier M, Boughaba MA. Residual neuromuscular blockade. Ann Fr Anesth Reanim 2005;24:1266-74.
11. Booij LH, de Boer HD, van Egmond J. Reversal agents for nondepolarizing neuromuscular blockade: reasons for and development of a new concept. Seminars in Anesthesia. Perioperative Medicine and Pain 2002;21:92-8.
12. Annila P, Yli-Hankala A, Lindgren L. Effect of atropine on the QT interval and T-wave amplitude in healthy volunteers. Br J Anaesth 1993;71:736-7.
13. Saarnivaara L, Simola M. Effects of four anticholinesterase-anticholinergic combinations and tracheal extubation on QTc interval of the ECG, heart rate and arterial pressure. Acta Anaesthesiol Scand 1998;42:460-3.
14. Epemolu O, Bom A, Hope F, Mason R. Reversal of neuromuscular blockade and simultaneous increase in plasma rocuronium concentra-tion after the intravenous infusion of the novel reversal agent Org 25969. Anesthesiology 2003;99:632-7.
15. Bartkowski RR. Incomplete reversal of pancuronium neuromuscular blockade by neostigmine, pyridostigmine, and edrophonium. Anesth Analg 1987;66:594-8.
16. Adam JM, Bennett DJ, Bom A, Clark JK, Feilden H, Hutchinson EJ, et al, editors. Cyclodextrin-derived host molecules as reversal agents for the neuromuscular blocker rocuronium bromide: synthesis and structure-activity relationships. J Med Chem 2002;45:1806-16.
17. Bom A, Bradley M, Cameron K, Clark JK, Van Egmond J, Feilden H, et al, editors. A novel concept of reversing neuromuscular block: chemical encapsulation of rocuronium bromide by a cyclodextrin-based synthetic host. Angew Chem Int Ed Engl 2002;41:266-70.
18. Nicholson WT, Sprung J, Jankowski CJ. Sugammadex: a novel agent for the reversal of neuromuscular blockade. Pharmacotherapy 2007;27:1181-8.
19. Gijsenbergh F, Ramael S, Houwing N, van Iersel T. First human exposure of Org 25969, a novel agent to reverse the action of rocuronium bromide. Anesthesiology 2005;103:695-703.
20. Sorgenfrei IF, Norrild K, Larsen PB, Stensballe J, Ostergaard D, Prins ME, et al, editors. Reversal of rocuronium-induced neuromuscular block by the selective relaxant binding agent sugammadex: a dose-finding and safety study. Anesthesiology 2006;104:667-74.
21. Shields M, Giovannelli M, Mirakhur RK, Moppett I, Adams J, Hermens Y. Org 25969 (sugammadex), a selective relaxant binding agent for antagonism of prolonged rocuronium-induced neuromuscular block. Br J Anaesth 2006;96:36-43.
22. Groudine SB, Soto R, Lien C, Drover D, Roberts K. A randomized, dose-finding, phase II study of the selective relaxant binding drug, Sugammadex, capable of safely reversing profound rocuronium-induced neuromuscular block. Anesth Analg 2007;104:555-62.
23. Eleveld DJ, Kuizenga K, Proost JH, Wierda JM. A temporary decrease in twitch response during reversal of rocuronium-induced muscle relaxation with a small dose of sugammadex. Anesth Analg 2007;104:582-4.
24. Sacan O, White PF, Tufanogullari B, Klein K. Sugammadex reversal of rocuronium-induced neuromuscular blockade: a comparison with neostigmine-glycopyrrolate and edrophonium-atropine. Anesth Analg 2007;104:569-74.
25. Vanacker BF, Vermeyen KM, Struys MM, Rietbergen H, Vandermeersch E, Saldien V, et al, editors. Reversal of rocuronium-induced neu-romuscular block with the novel drug sugammadex is equally effective under maintenance anesthesia with propofol or sevoflurane. Anesth Analg 2007;104:563-8.
26. Reid JE, Breslin DS, Mirakhur RK, Hayes AH. Neostigmine antagonism of rocuronium block during anesthesia with sevoflurane, isoflurane or propofol. Can J Anaesth 2001;48:351-5.
27. Eriksson LI. Evidence-based practice and neuromuscular monitoring: it’s time for routine quantitative assessment. Anesthesiology 2003;98:1037-9.
28. Fuchs-Buder T, Mencke T. Use of reversal agents in day care procedures (with special reference to postoperative nausea and vomiting). Eur J Anaesthesiol Suppl 2001;23:53-9.
29. Caldwell JE. New skeletal muscle relaxants. Int Anesthesiol Clin 1995;33:39-60.
30. Bettelli G. Which muscle relaxants should be used in day surgery and when. Curr Opin Anaesthesiol 2006;19:600-5.
31. Baillard C, Clec’h C, Catineau J, Salhi F, Gehan G, Cupa M, et al, editors. Postoperative residual neuromuscular block: a survey of man-agement. Br J Anaesth 2005;95:622-6.
32. Kopman AF, Sinha N. Acceleromyography as a guide to anesthetic management: a case report. J Clin Anesth 2003;15:145-8.
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