Díaz JTJ, Athíe GJM, Martínez RV

Language: Spanish
References: 12
Page: 189-193
PDF size: 162.42 Kb.

ABSTRACT

Objective: To detect the patients who are managed with rocuronium and show residual neuromuscular blockade, and compare the reversal agent, neostigmine versus sugammadex, until effective reversal is obtained. Methodology: 61 patients were included who underwent rhinoseptoplasty under balanced general anesthesia with rocuronium at a dose of 0.6 mg/kg. The TOF was obtained, and if ≤ 0.9, it was reverted randomly with sugammadex (group 1) 2 mg/kg or neostigmine plus atropine (group 2) 0.04 + 0.02 mg/kg. Results: For group 1 (n = 31 patients), the anesthetic time was 61 min, the average residual relaxation was 64% and it was reversed in 2.5 min, reaching 98% recovery. For group 2 (n = 30), the anesthetic time was 59 min, the average residual relaxation was 57%, which was reversed in 11.9 min, reaching a 93% recovery. Conclusions: Both drugs, neostigmine and sugammadex show satisfactory reversal of residual block (TOF 0.90). However, sugammadex reaches effective reversal (TOF 0.98) and it reverts in a shorter time compared with neostigmine, 10 times faster.

REFERENCES

1. Salomé B, Viana C, Coelho V, Silva A. Bloqueo neuromuscular residual después del uso de rocuronio o cisatracurio. Revista Brasileña de Anestesiología. 2005; 55 (6): 612-616.

2. Murphy GS, Szokol JW, Marymont JH, Greenberg SB, Avram MJ, Vender JS. Residual neuromuscular blockade and critical respiratory events in the postanesthesia care unit. Anesth Analg. 2008; 107 (1): 130-137.

3. Fabregat JL, Candia C A, Castillo C. Neuromuscular monitoring and its importance in neuromuscular blockade. Colombian Journal of Anesthesiology. 2012; 40 (4): 293-303.

4. Claudet M. Eficacia y eficiencia del tubo bucofaríngeo con succión continua -tubo de Claudet- para mantener el control de la vía aérea durante la rinoseptoplastia con anestesia local bajo sedación. Actas Peru Anestesiol. 2012; 20: 21-26.

5. Castilla L. Sugammadex: seguridad en la reversión del bloqueo neuromuscular no despolarizante. Actas Peru Anestesiol. 2011; 19: 20-22.

6. Sabo D, Jones K, Berry J. Residual neuromuscular blockade at extubation: a randomized comparision of sugammadex and neostigmine reversal of rocuronium- induced blockade in patients undergoing abdominal surgery. Anesthesia and Clinical Research. 2011; 2: 2-6.

7. Kovac AL. Sugammadex: the first selective binding reversal agent for neuromuscular block. J Clin Anesth. 2009; 21 (6): 444-453.

8. 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 (1): 63-68.

9. Pongrácz A, Szatmári S, Nemes R, Fülesdi B, Tassonyi E. Reversal of neuromuscular blockade with sugammadex at the reappearance of four twitches to train-of-four stimulation. Anesthesiology. 2013; 119 (1): 36-42.

10. McDonagh DL, Benedict PE, Kovac AL, Drover DR, Brister NW, Morte JB et al. Efficacy, safety, and pharmacokinetics of sugammadex for the reversal of rocuronio-induced neuromuscular blockade in elderly patiens. Anaesthesiology. 2011; 114: 310-329.

11. Ortiz G, Pérez J. Reversión del bloqueo neuromuscular residual por atracurio y vecuronio con dosis bajas de neostigmina. Anales Sis San Navarra. 2006; 29: 189-198.

12. Sacan O, White PF, Tufanogullari B, Klein K. Sugammadex reversal of rocuronium-induced neuromuscular blockade: a comparison with neostigmine–glycopyrrolate and edrophonium-atropine. International Anesthesia Research Society. 2007; 104: 569-574.