Reversal agents for nondepolarizing neuromuscular blockade: Reasons for and development of a new concept

2002 ◽  
Vol 21 (2) ◽  
pp. 92-98 ◽  
Author(s):  
Leo H.D.J. Booij ◽  
Hans D. de Boer ◽  
Jan van Egmond
Keyword(s):  
Neuromuscular Blockade ◽  
Reversal Agents ◽  
Nondepolarizing Neuromuscular Blockade

LOCALIZED HYPOTHERMIA POTENTIATES NONDEPOLARIZING NEUROMUSCULAR BLOCKADE

1988 ◽  
Vol 69 (3A) ◽  
pp. A294-A294 ◽  
Author(s):  
C W Hanson ◽  
M L Young ◽  
M J Bloom ◽  
S Muravchick ◽  
J Savino
Keyword(s):  
Neuromuscular Blockade ◽  
Nondepolarizing Neuromuscular Blockade

A880 DOUBLE BURST STIMULATION ASSESSMENT OF NONDEPOLARIZING NEUROMUSCULAR BLOCKADE

1990 ◽  
Vol 73 (3A) ◽  
pp. NA-NA ◽  
Author(s):  
E. P. Anderson ◽  
K. A. Jones ◽  
E. P. Stensrud ◽  
R. L. Lennon
Keyword(s):  
Neuromuscular Blockade ◽  
Burst Stimulation ◽  
Double Burst Stimulation ◽  
Nondepolarizing Neuromuscular Blockade

scholarly journals Usefulness of intra-operative neuromuscular blockade monitoring and reversal agents for postoperative residual neuromuscular blockade: a retrospective observational study

2019 ◽  
Author(s):  
Gonzalo Domenech ◽  
Matias Kampel ◽  
Maria Eugenia Garcia Guzzo ◽  
Delfina Sanchez Novas ◽  
Sergio Terrasa ◽  
...  
Keyword(s):  
Neuromuscular Blockade ◽  
Multivariable Analysis ◽  
Perioperative Period ◽  
University Hospital ◽  
Exclusion Criterion ◽  
Adductor Pollicis Muscle ◽  
Residual Neuromuscular Blockade ◽  
Reversal Agents ◽  
Elective Surgical Procedures ◽  
Train Of Four

Abstract Background: Current neuromuscular blockade (NMB) management techniques cannot completely prevent residual NMB (RNMB) during the postoperative period. Evidently, compliance to NMB monitoring is persistently low, and the risk of RNMB during the perioperative period remains underestimated. We have not found publications that report the incidence of RNMB in a university hospital where access to quantitative NMB monitoring and sugammadex is unlimited and where NMB management is not protocolised. The primary aim of this study was to estimate the incidence of RNMB in patients managed with or without sugammadex or neostigmine as antagonists and quantitative NMB monitoring in the operating room. The secondary aim was to explore the associations between RNMB and potentially related variables. Methods: This retrospective observational cohort study was conducted at a tertiary referral university hospital in Buenos Aires, Argentina. Records created between June 2015 and December 2015 were reviewed. In total, 240 consecutive patients who had undergone elective surgical procedures requiring NMB were included. All patients were monitored via acceleromyography at the adductor pollicis muscle within 5 min of arrival in the postanaesthesia care unit. Scheduled recovery in the intensive care unit was the only exclusion criterion. The primary outcome was the presence of RNMB, defined as a train-of-four ratio of <0.9. The secondary outcomes were the associations between RNMB and potentially related variables. Results: RNMB was present in 1.6% patients who received intra-operative quantitative NMB monitoring and 32% patients whose NMB was not monitored (P<0.01). Multivariable analysis revealed that the use of intra-operative quantitative NMB monitoring and sugammadex were associated with a lower incidence of RNMB, with calculated odds ratios of 0.04 (95% confidence interval [CI]: 0.005 to 0.401) and 0.18 (95% CI: 0.046 to 0.727), respectively. Conclusions: The results of the present study suggest that quantitative intra-operative NMB monitoring and use of sugammadex are associated with a decreased incidence of RNMB in the PACU, reinforcing the contention that the optimal strategy for RNMB avoidance is the use of quantitative NMB monitoring and eventual use of reversal agents, if needed, prior to emergence from anaesthesia.

Spontaneous Recovery From Nondepolarizing Neuromuscular Blockade

1977 ◽  
Vol 56 (1) ◽  
pp. 55???58 ◽  
Author(s):  
JEFFRY B. BRAND ◽  
DAVID J. CULLEN ◽  
NORMAN E. WILSON ◽  
HASSAN H. ALI
Keyword(s):  
Neuromuscular Blockade ◽  
Spontaneous Recovery ◽  
Nondepolarizing Neuromuscular Blockade

Cardiac Arrest and Neuromuscular Blockade Reversal Agents in the Transplanted Heart

2013 ◽  
Vol 27 (6) ◽  
pp. 1374-1378 ◽  
Author(s):  
Gianluca Bertolizio ◽  
Koichi Yuki ◽  
Kirsten Odegard ◽  
Vincent Collard ◽  
James DiNardo
Keyword(s):  
Cardiac Arrest ◽  
Neuromuscular Blockade ◽  
Reversal Agents ◽  
Neuromuscular Blockade Reversal

A879 DOUBLE BURST STIMULATION ASSESSMENT OF NONDEPOLARIZING NEUROMUSCULAR BLOCKADE

1990 ◽  
Vol 73 (3A) ◽  
pp. NA-NA
Author(s):  
K. A. Jones ◽  
R. L. Lennon ◽  
P. E. Stensrud ◽  
J. G. Weber ◽  
M. J. Joyner
Keyword(s):  
Neuromuscular Blockade ◽  
Burst Stimulation ◽  
Double Burst Stimulation ◽  
Nondepolarizing Neuromuscular Blockade

scholarly journals Repeat Administration of Reversal Agents in Patients Receiving Neostigmine or Sugammadex: A Retrospective Observational Study

2020 ◽  
Author(s):  
Laura Gilbertson ◽  
Francis Wolf ◽  
Grant C. Lynde
Keyword(s):  
Neuromuscular Blockade ◽  
Repeated Administration ◽  
Not Given ◽  
Reversal Agent ◽  
Progressive Decline ◽  
Residual Neuromuscular Blockade ◽  
Reversal Agents ◽  
Rescue Dose ◽  
Repeat Administration ◽  
Effective Use

Abstract Background: Antagonism of neuromuscular blockade (NMB) induced by rocuronium and vecuronium can be achieved with either neostigmine or sugammadex. Compared to sugammadex, antagonism with neostigmine is more likely to result in incomplete reversal, i.e. residual neuromuscular blockade (rNMB). The administration of additional doses of a reversal agent following an initial reversal dose may be a marker for suspected rNMB. We studied the frequency and temporal patterns of repeat (rescue) administration of reversal agents in patients who received an initial dose of neostigmine vs. sugammadex. Methods: We analyzed retrospective data from electronic anesthesia records to identify surgical patients who received rescue dose reversal, defined as two or more doses of reversal agent, following administration of non-depolarizing NMB and extubation in the operating room. We assessed rates of rescue reversal over time following the introduction of sugammadex and compared rescue rates for patients receiving neostigmine vs sugammadex. Results: A total of 24,027 cases using cisatracurium, rocuronium, and vecuronium were analyzed. Following the addition of sugammadex to formulary in 2016, reversal with neostigmine decreased from 79% to 5.3% (p <0.001) and the use of rescue reversal after neostigmine increased from 6.0% to 18% (p<0.001). In contrast, rescue reversal after sugammadex was 2.5%, with no change over the study period (p=0.059). The percentage of patients who were not given any reversal agent following non-depolarizing NMB decreased from 20% to 13% (p<0.001). As neostigmine usage progressively decreased after introduction of sugammadex, there was a corresponding increase in rescue reversal dosing when initial reversal was attempted with neostigmine. Conclusions: Repeated administration of a reversal agent was 7 times more likely to occur in patients initially reversed with neostigmine compared to sugammadex. This finding likely reflects increased rates of observed weakness in patients reversed with neostigmine. The correlation between decreasing neostigmine use and increasing rescue reversal after neostigmine may indicate a progressive decline in the effective use of neostigmine (as knowledge and experience waned), and/or decreasing confidence in its efficacy.

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