Sugammadex in ICU

Q: Sugammadex reverses the neuromuscular blockade (NMBAs) of all of the following except? 

 A) rocuronium 
B) vecuronium 
C) pancuronium 
D) pipecuronium 
E) succinylcholine


Answer: E 

 Sugammadex only inactivates steroidal NMBAs by encapsulating them. It works best for rocuronium. It has no effect on succinylcholine which is a different class of NMBAs. This is an important drug/reversal to know for an intensivist as in case if rocuronium is used for intubation, and intubation turns out to be a difficult situation, sugammadex can reverse the muscular blockade and patient can be rescued with bag and mask ventilation. The dose in such scenario is 16 mg/kg. Reversal occurs within three minutes. Care should be taken in the calculation of dose as a higher dose may cause anaphylaxis or bradycardia. It is not recommended in end-stage renal disease (ESRD) patients.

#procedures
#pharmacology


References:

1. Bom A, Hope F, Rutherford S, Thomson K. Preclinical pharmacology of sugammadex. J Crit Care 2009; 24:29. 

2. Hristovska AM, Duch P, Allingstrup M, Afshari A. Efficacy and safety of sugammadex versus neostigmine in reversing neuromuscular blockade in adults. Cochrane Database Syst Rev 2017; 8:CD012763. 

3. Sørensen MK, Bretlau C, Gätke MR, et al. Rapid sequence induction and intubation with rocuronium-sugammadex compared with succinylcholine: a randomized trial. Br J Anaesth 2012; 108:682.

4. Cammu G, Van Vlem B, van den Heuvel M, et al. Dialysability of sugammadex and its complex with rocuronium in intensive care patients with severe renal impairment. Br J Anaesth 2012; 109:382.  

5. Tsur A, Kalansky A. Hypersensitivity associated with sugammadex administration: a systematic review. Anaesthesia 2014; 69:1251. 

6. Bhavani SS. Severe bradycardia and asystole after sugammadex. Br J Anaesth 2018; 121:95.