Sugammadex as Rescue Therapy

Launched by EMORY UNIVERSITY · Dec 14, 2022

Keywords

ClinConnect Summary

Neuromuscular blocking (NMB) agents are commonly used in the practice of anesthesiology for skeletal muscle relaxation to facilitate tracheal intubation, and may require reversal in order to prevent residual NMB. This was historically done using an anticholinesterase such as neostigmine, which has many adverse effects and may not effectively reverse a deep NMB. However, the introduction of sugammadex was instrumental in allowing the rapid return of neuromuscular function. The FDA has only approved three doses of sugammadex (2 mg/kg, 4 mg/kg and 16 mg/kg) depending on the train of four (TOF)...

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • Patients aged 18 years and above who will undergo an elective surgery in the main operating room or outpatient surgery center at Grady Memorial Hospital
• • Receive general anesthesia (standardized to sevoflurane for maintenance)
• • Receive rocuronium for NMB
• • Receive neostigmine for NMB reversal
• • Achieve a TOF count of at least 3 twitches but not a TOF ratio of 0.9 fifteen minutes after neostigmine has been given
• • Able and willing to provide informed consent.
• Exclusion Criteria:
• • Pregnancy and/or lactating
• • BMI ≥ 40
• • Severe renal impairment, i.e. chronic kidney disease stages IV and V as defined by GFR \< 30 ml/min/1.73 m2
• • Severe hepatic impairment, i.e. Child-Pugh score C
• • Pre-existing neuromuscular disease
• • Anticipated need for postoperative intubation, and/or known hypersensitivity reactions to rocuronium, neostigmine and/or sugammadex.
• • Adults unable to consent
• • Prisoners
• • Cognitively impaired or Individuals with Impaired Decision-Making Capacity
• • Individuals who are not able to clearly understand English

Trial Officials