//fpnotebook.com/
Sugammadex
Aka: Sugammadex, Bridion
- Indications
- Rapid reversal of Rocuronium and Vecuronium (Non-depolarizing Neuromuscular Blocking Agents)
- FDA approved for reversal in adult surgery cases, to speed recovery after case completion
- Follow neurologic status in neurologic catastrophe (e.g. Intracranial Hemorrhage) or Status Epilepticus
- Emergency paralytic reversal is off-label use and may not be ideal
- A patient who requires emergent Endotracheal Intubation still needs an airway
- Reversal agents render further Non-depolarizing Neuromuscular Blocking Agent use ineffective
- Can't Intubate but CAN ventilate scenarios may be treated with temporarily with BVM or LMA
- Can't Intubate, Can't Ventilate scenarios require emergency Cricothyrotomy
- Paralysis reversal may worsen this situation and delay definitive management
- References
- Strayer in Herbert (2019) EM:RAP 19(11):4-6
- Background
- Approved in Europe in 2008
- FDA approved in U.S. in 2016 (initially rejected due to Anaphylaxis risk)
- Mechanism
- Sugammadex tightly binds Rocuronium and Vecuronium
- Prevents paralytic binding to acetylcholine receptors
- Pharmacokinetics
- Reverses paralysis within 3-4 minutes
- Dosing
- Typical dose: 4 mg/kg total body weight
- Rapid reversal dose: 16 mg/kg total body weight
- Adverse Effects
- Anaphylaxis in 0.3% of patients
- Bradycardia
- References
- Braude and Hayes in Herbert (2016) EM:Rap 16(11): 7