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sugammadex

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

  • 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)

P/K

  • 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.

adverse effects

  • 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

C/I

  • HS to sugammadex
  • children less than two years

interactions

  • 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

references

sugammadex.txt · Last modified: 2015/03/13 16:12 (external edit)