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Kidney sugammadex

Yasemin Isik, Onur Palabiyik, Bilal Muhammed Cegin, Ugur Goktas, Ismail Kati
BACKGROUND: Neostigmine, the currently commonly used agent for reversal of neuromuscular blockade. Sugammadex is a novel and unique compound designed as an antagonist of steroidal neuromuscular blockers. In this study, we evaluated the effects of sugammadex or neostigmine on kidney functions in patients scheduled for elective surgery. MATERIAL/METHODS: Patients scheduled for a surgical procedure under desflurane/opioid anesthesia received an intubating dose rocuronium...
2016: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
Camila M de Souza, Maria A Tardelli, Helio Tedesco, Natalia N Garcia, Mario P Caparros, Jose A Alvarez-Gomez, Itamar S de Oliveira Junior
BACKGROUND: Renal failure affects the pharmacology of nondepolarizing neuromuscular blockers making recovery of neuromuscular function unpredictable. Sugammadex antagonises rocuronium-induced neuromuscular blockade by encapsulating rocuronium, creating a stable complex molecule that is mainly excreted by the kidneys. Previous studies suggest that sugammadex is effective in reversing moderate neuromuscular block in the presence of renal failure, but no data are available regarding reversal of profound neuromuscular block in patients with renal failure...
October 2015: European Journal of Anaesthesiology
N Rahe-Meyer, C Berger, M Wittmann, C Solomon, E A M Abels, H Rietbergen, D A Reuter
BACKGROUND: Deep neuromuscular blockade (NMB) may not always be maintained to the end of surgery and the depth of block may be allowed to gradually diminish over time, particularly if reversal of NMB is not routinely performed. AIM: The current study aimed to assess recovery from deep rocuronium-induced NMB with sugammadex compared with placebo, provide data regarding the extent of residual blockade after deep rocuronium-induced NMB (placebo group), and to determine whether complete and reliable recovery could be provided by sugammadex (sugammadex group)...
July 2015: Der Anaesthesist
Pieter-Jan de Kam, Jie Hou, Zaiqi Wang, Wen Hong Lin, Michiel van den Heuvel
OBJECTIVE: Elimination of sugammadex occurs predominantly via the kidneys, with the majority of the drug excreted unchanged in the urine. To date, most studies with sugammadex have been performed in non-Asian populations. The objectives of this open-label study were to determine the pharmacokinetics (PK) and safety of single-dose sugammadex (16 mg/kg) in healthy Chinese adult volunteers. METHODS: 12 Chinese subjects (6 male; 6 female) received intravenous sugammadex (16 mg/kg) as a 10-second bolus infusion...
June 2015: International Journal of Clinical Pharmacology and Therapeutics
Tatsuhiko Shimizu, Yuichiro Toda, Kazuyoshi Shimizu, Tatsuo Iwasaki, Tomoyuki Kanazawa, Noriko Ishii, Kentaro Sugimoto, Hirokazu Kawase, Kiyoshi Morita
It is known that blood concentration of rocuronium increases after administration of sugammadex, but this is not clear in the case of vecuronium. We report a pediatric case in which serum vecuronium concentration increased following sugammadex administration after prolonged sedation using vecuronium. A 19-month-old girl weighing 7.8 kg had a history of aortic valvuloplasty at 4 months of age due to truncus arteriosus. She presented again to our hospital due to aortic regurgitation. She underwent aortic valvuloplasty and then aortic valve replacement...
October 2013: Masui. the Japanese Journal of Anesthesiology
Martijn Boon, Christian H Martini, Leon P H J Aarts, Rob F M Bevers, Albert Dahan
BACKGROUND: Surgical conditions in laparoscopic surgery are largely determined by the depth of neuromuscular relaxation. Especially in procedures that are confined to a narrow working field, such as retroperitoneal laparoscopic surgery, deep neuromuscular relaxation may be beneficial. Until recently, though, deep neuromuscular block (NMB) came at the expense of a variety of issues that conflicted with its use. However, with the introduction of sugammadex, rapid reversal of a deep NMB is feasible...
2013: Trials
G Cammu, B Van Vlem, M van den Heuvel, L Stet, R el Galta, S Eloot, I Demeyer
BACKGROUND: Renal excretion is the primary route for the elimination of sugammadex. We evaluated the dialysability of sugammadex and the sugammadex-rocuronium complex in patients with severe renal impairment in the intensive care unit (ICU). METHODS: Six patients in the ICU with acute severe renal impairment received general anaesthesia for transoesophageal echocardiography, to replace their tracheal tubes, or for bronchoscopy. Five of the six patients were in the ICU after cardiac/vascular surgery and one for pneumonia-induced respiratory failure...
September 2012: British Journal of Anaesthesia
I Cordero Escobar, B Rey Martínez, R Company Teuler, A Pérez Carbonell
We report the use of sugammadex to reverse a rocuronium block in a man who had received a kidney transplant 4 years earlier. The patient was admitted for gastric non-Hodgkins lymphoma and bleeding that required surgery. Arterial hypertension, tachycardia, and frequent ventricular extrasystoles were detected. Anesthetic induction was accomplished with propofol, fentanyl, and rocuronium; intubation was uneventful. We monitored pulse oximetry, capnography, heart rate, electrocardiography, arterial pressure (invasive), cardiac output, end-systolic volume, bispectral index, temperature, and neuromuscular function...
December 2011: Revista Española de Anestesiología y Reanimación
Habib Bostan, Yıldıray Kalkan, Yakup Tomak, Levent Tumkaya, Durdu Altuner, Adnan Yılmaz, Baar Erdivanli, Recep Bedir
BACKGROUND: This study investigated the effect of injection of rocuronium or sugammadex alone and rocuronium + sugammadex on urea, creatinine, electrolyte levels, and histopathological findings in rats. METHODS: Thirty-six Sprague-Dawley male rats were divided to receive intravenously 16 or 96 mg/kg sugammadex, 1 mg/kg rocuronium, 1 mg/kg rocuronium + 16 mg/kg sugammadex, or 1 mg/kg rocuronium + 96 mg/kg sugammadex. The control group received an equal volume of physiological serum...
2011: Renal Failure
O Menouni, A-C Brillouet-Banchereau, G Galan, A Lélias, A Sautereau, S Gadrey
Postoperative curarization in patients has been established. Nevertheless, extremely prolonged neuromuscular blockades are rare. We report the case of a prolonged neuromuscular blockade (lasting 10 hours) following a single dose of rocuronium, in an elderly patient with severe renal failure. We have studied the possible causes of prolonged curarization, and discussed the interest of the use of sugammadex in such cases.
November 2011: Annales Françaises D'anesthèsie et de Rèanimation
M Briere, C Boisson, P Cuvillon, B Debaene, J Ripart
We report a case of delayed rocuronium-induced deep block antagonization with sugammadex, thus requiring a total of three injections and a cumulative dose of 12 mg/kg over a 30 min period. The patient was an emergency case with full stomach that had required a rapid sequence induction. Because of hyperkaliemia due to an acute renal failure, rocuronium was preferred to succinylcholine. Use of sugammadex in the acute renal failure context is discussed.
October 2011: Annales Françaises D'anesthèsie et de Rèanimation
Huub J Kleijn, Daniel P Zollinger, Michiel W van den Heuvel, Thomas Kerbusch
AIMS: An integrated population pharmacokinetic-pharmacodynamic model was developed with the following aims: to simultaneously describe pharmacokinetic behaviour of sugammadex and rocuronium; to establish the pharmacokinetic-pharmacodynamic model for rocuronium-induced neuromuscular blockade and reversal by sugammadex; to evaluate covariate effects; and to explore, by simulation, typical covariate effects on reversal time. METHODS: Data (n= 446) from eight sugammadex clinical studies covering men, women, non-Asians, Asians, paediatrics, adults and the elderly, with various degrees of renal impairment, were used...
September 2011: British Journal of Clinical Pharmacology
Pierre Peeters, Paul Passier, Jean Smeets, Alex Zwiers, Marcel de Zwart, Saskia van de Wetering-Krebbers, Marlou van Iersel, Sjoerd van Marle, Diels van den Dobbelsteen
Sugammadex is a modified γ-cyclodextrin which rapidly reverses rocuronium-and vecuronium-induced neuromuscular blockade. Previous studies suggest that sugammadex is mostly excreted unchanged via the kidneys. This single-center, open-label, non-randomized study used (14)C-labeled sugammadex to further investigate the excretion, metabolic and pharmacokinetic (PK) profiles of sugammadex in six healthy male volunteers. (14)C-labeled sugammadex 4 mg/kg (0.025 MBq/kg of (14)C-radioactivity) was administered as a single intravenous bolus...
April 2011: Biopharmaceutics & Drug Disposition
Lonneke M Staals, Hans D de Boer, Jan van Egmond, Frank Hope, Francien van de Pol, Anton H Bom, Jacques J Driessen, Leo H D J Booij
PURPOSE: Sugammadex is a selective relaxant binding agent designed to encapsulate the aminosteroidal neuromuscular blocking agent rocuronium, thereby reversing its effect. Both sugammadex and the sugammadex-rocuronium complex are eliminated by the kidneys. This study investigated the effect of sugammadex on recovery of rocuronium-induced neuromuscular block in cats with clamped renal pedicles, as a model for acute renal failure. METHODS: Twelve male cats were divided into two groups and anesthetized with medetomidine, ketamine, and alpha-chloralose...
April 2011: Journal of Anesthesia
L M Staals, M M J Snoeck, J J Driessen, H W van Hamersvelt, E A Flockton, M W van den Heuvel, J M Hunter
BACKGROUND: Sugammadex is a selective relaxant binding agent designed to encapsulate the neuromuscular blocking agent, rocuronium. The sugammadex-rocuronium complex is eliminated by the kidneys. This trial investigated the pharmacokinetics (PKs) of sugammadex and rocuronium in patients with renal failure and healthy controls. METHODS: Fifteen ASA class II-III renal patients [creatinine clearance (CL(CR)) <30 ml min(-1)] and 15 ASA I-II controls (CL(CR) > or =80 ml min(-1)) were included...
January 2010: British Journal of Anaesthesia
B Debaene, C Meistelman
Sugammadex, a cyclodextrin, is a novel agent designed to encapsulate selectively steroidal neuromuscular blocking agents such as rocuronium and vecuronium as well. One molecule of sugammadex is able to encapsulate only one molecule of muscle relaxant. This original pharmacological property allows a very rapid reversal of muscle paralysis. After sugammadex injection, a train of four ratio higher than 0.9 is obtained in less than 5 minutes in all the patients whatever the degree of muscle paralysis at the time of reversal and even when anesthesia is maintained with halogenated agents...
September 2009: Annales Françaises D'anesthèsie et de Rèanimation
Christopher Rex, Friedrich K Pühringer
Cyclodextrins consist of rings of sugar molecules with a lipophilic core and a hydrophilic periphery. Thus they are well soluble in water and possess the ability to bind (encapsulate) steroid molecules. Cyclodextrins have now been modified (sugammadex) in such a way a perfect complex formation with rocuronium results. In this way an alternative to the classical indirect antagonists has been discovered. It is now possible to terminate a neuromuscular blockade via an intravasal encapsulation of rocuronium far distant from the neuromuscular endplates and avoiding the side effects associated with acetylcholinestase inhibitors instead of by an intervention in the acetylcholine system...
May 2009: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
R G Craig, J M Hunter
The pharmacodynamics and pharmacokinetics of the currently available neuromuscular blocking and reversal drugs may be altered by organ disease. Adverse effects such as prolonged neuromuscular block, postoperative residual curarisation, recurarisation, the muscarinic effects of the anticholinesterases, and the side-effects of the antimuscarinics are encountered more frequently. This review will consider these potential problems and assess the role of sugammadex in enabling the anaesthetist to avoid them. It will also present the latest knowledge regarding the safety and efficacy of sugammadex in patients with renal, hepatic, cardiovascular and pulmonary disease...
March 2009: Anaesthesia
L M Staals, M M J Snoeck, J J Driessen, E A Flockton, M Heeringa, J M Hunter
BACKGROUND: Sugammadex, a modified gamma-cyclodextrin, is the first selective relaxant binding agent that specifically encapsulates the steroidal neuromuscular blocking agent, rocuronium. The action of rocuronium is prolonged in patients with renal failure. As sugammadex is primarily cleared renally, this phase III trial investigated the efficacy and safety of sugammadex for reversal of rocuronium-induced neuromuscular block (NMB) in patients with end-stage renal failure. METHODS: Thirty adult patients were studied: 15 renally impaired [creatinine clearance (CL(CR)) <30 ml min(-1)] and 15 controls (CL(CR)>80 ml min(-1))...
October 2008: British Journal of Anaesthesia
François Donati
BACKGROUND: Neuromuscular blocking agents are used to provide relaxation and immobility during surgery. To avoid residual paralysis after anaesthesia, reversal of blockade is commonly accomplished with anticholinesterase agents but these drugs have cardiovascular side effects and incomplete effectiveness. Sugammadex is a cyclodextrin that binds rocuronium and chemically similar neuromuscular blocking drugs. OBJECTIVE: Published data on the effectiveness of sugammadex as a reversal agent were examined...
June 2008: Expert Opinion on Pharmacotherapy
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