Do we need to use sugammadex at the end of a general anesthesia to reverse the action of neuromuscular bloking agents? Position paper on sugammadex use

G. Della Rocca, P. Di Marco, L. Beretta, A. R. De Gaudio, C. Ori, R. Mastronardi

Research output: Contribution to journalArticle

Abstract

Sugammadex, the first selective relaxant-binding agent indicated to reverse the neuromuscular blockade induced during general anesthesia, was recently introduced into clinical practice. In the present report, the following issues pertinent to the use of sugammadex in anesthesia practice are discussed: the intraoperative use of NMBAs and the incidence of postoperative residual curarization (PORC); the efficacy and safety of rocuronium plus sugammadex compared to succinylcholine for rapid sequence induction; the availability of sugammadex in hospitals; and, finally, some relevant legal medical aspects. Sugammadex is considerably more expensive than neostigmine, but its use can be advocated based on its safety and efficacy profile as a reversal agent of steroidal neuro muscular blocking agents (NMBAs), and as a mean to prevent PORC. The availability of sugammadex in Italian hospitals may have a beneficial impact on patient safety. This is due to the fact that PORC is a common and dangerous condition that may lead to postoperative inhalational events, hypoxemia, and pneumonia; and at the moment, it is not completely preventable even when advanced neuro-muscolar monitoring techniques are applied". In the case of rapid sequence intubation (RSI), rocuronium (1.2 mg/kg) administration followed by sugammadex represents a better choice in terms of efficacy and safety than succinylcholine. If a new drug is proven to be safer and more efficient than the one it is replacing, hospitals should consider the new drug and make it available, at least fot selected patients or in situations at risk of severe complications. It is reasonable to hypothesize that, when discussing informed consent for elective procedures, patients and families may want to know if the admitting facilities have the superior agent available, and that the absence of such agent could create concerns and complains.

Original languageEnglish
Pages (from-to)661-666
Number of pages6
JournalMinerva Anestesiologica
Volume79
Issue number6
Publication statusPublished - Jun 2013

Fingerprint

Neuromuscular Agents
General Anesthesia
Delayed Emergence from Anesthesia
Succinylcholine
Safety
Neostigmine
Neuromuscular Blockade
Jurisprudence
Patient Safety
Sugammadex
Informed Consent
Intubation
Pharmaceutical Preparations
Pneumonia
Anesthesia
Incidence

Keywords

  • Neuromuscular blocking agents
  • Reversal learning
  • Sugammadex

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Do we need to use sugammadex at the end of a general anesthesia to reverse the action of neuromuscular bloking agents? Position paper on sugammadex use. / Della Rocca, G.; Di Marco, P.; Beretta, L.; De Gaudio, A. R.; Ori, C.; Mastronardi, R.

In: Minerva Anestesiologica, Vol. 79, No. 6, 06.2013, p. 661-666.

Research output: Contribution to journalArticle

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