sugammadex

introduction

sugammadex is a modified gamma cyclodextrin designed to selectively reverse the effects of the neuromuscular blockers rocuronium and vecuronium
marketed as Bridion (Schering Plough) in vials containing 100 mg/mL solution for injection

dose of sugammadex depends on the degree of neuromuscular blockade required
in situations where immediate reversal of rocuronium-induced blockade is required, the recommended dose is 16 mg/kg of sugammadex three minutes after rocuronium administration.
sugammadex (4 mg/kg) was more effective than neostigmine (70 microgram/kg) at reversing profound neuromuscular blockade induced by rocuronium or vecuronium.
- mean time to recovery of muscle function (measured using an acceleromyograph) was three minutes after the sugammadex injection compared to 50 minutes after neostigmine
sugammadex (2 mg/kg) was also quicker than neostigmine (50 microgram/kg) at reversing moderate neuromuscular blockade (mean recovery times of 1-2 mins vs 16-18 mins)

elimination half-life of 2.2 hours after iv injection
- increased in elderly
- reduced in children
- if re-administration of rocuronium or vecuronium is required after reversal with sugammadex, a waiting period is recommended. The duration depends on the dose of sugammadex, the dose of rocuronium or vecuronium, and the patient's renal function.

metallic or bitter taste esp. at high dose 32mg/kg
recurrent blockade has occurred (2% of patients), however this was mostly associated with a suboptimal dose of sugammadex (less than 2 mg/kg)
1% have body movement, coughing or grimacing during the anaesthetic
allergic reactions, such as flushing or erythematous rash, have been observed with sugammadex

toremifene, fusidic acid and flucloxacillin can displace vecuronium or rocuronium from the complex with sugammadex
may decrease progestogen concentrations with risk of failed contraception, similar to the decrease observed after missing a daily dose of an oral contraceptive
- women on the pill should refer to the missed dose advice for their contraceptive
- women using non-oral hormonal contraceptives, such as depot formulations, should be advised to use additional contraception for the next seven days
may affect haemostasis by interfering with the coagulation cascade. Patients with pre-existing coagulation abnormalities should therefore be monitored for activated partial thromboplastin time, prothrombin time and INR
prolongation of the QTc interval has been noted in some patients- care when used with other agents which also do this such as anaesthetics sevoflurane and propofol