II. Indications

  1. Rapid reversal of Rocuronium and Vecuronium (Non-depolarizing Neuromuscular Blocking Agents)
  2. FDA approved for reversal in adult surgery cases, to speed recovery after case completion
  3. Follow neurologic status in neurologic catastrophe (e.g. Intracranial Hemorrhage) or Status Epilepticus
  4. Emergency paralytic reversal is off-label use and may not be ideal
    1. A patient who requires emergent Endotracheal Intubation still needs an airway
    2. Reversal agents render further Non-depolarizing Neuromuscular Blocking Agent use ineffective
    3. Can't Intubate but CAN ventilate scenarios may be treated with temporarily with BVM or LMA
    4. Can't Intubate, Can't Ventilate scenarios require emergency Cricothyrotomy
      1. Paralysis reversal may worsen this situation and delay definitive management
    5. References
      1. Strayer in Herbert (2019) EM:RAP 19(11):4-6

III. Background

  1. Approved in Europe in 2008
  2. FDA approved in U.S. in 2016 (initially rejected due to Anaphylaxis risk)

IV. Mechanism

  1. Sugammadex tightly binds Rocuronium and Vecuronium
  2. Prevents paralytic binding to acetylcholine receptors

V. Pharmacokinetics

  1. Reverses paralysis within 3-4 minutes

VI. Dosing

  1. Typical dose: 4 mg/kg total body weight
  2. Rapid reversal dose: 16 mg/kg total body weight

VII. Adverse Effects

  1. Anaphylaxis in 0.3% of patients
  2. Bradycardia

VIII. References

  1. Braude and Hayes in Herbert (2016) EM:Rap 16(11): 7

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Ontology: Sugammadex (C1700695)

Concepts Pharmacologic Substance (T121) , Carbohydrate (T118)
MSH C453980
SnomedCT 442379000, 442340006
English Sugammadex (product), Sugammadex (substance), Sugammadex, sugammadex, SUGAMMADEX
Spanish sugammadex, sugammadex (sustancia), sugammadex (producto)

Ontology: Bridion (C2699711)

Concepts Pharmacologic Substance (T121)
English Bridion