SEARCH RESULTS FOR: Sugammadex

Rapid Sequence Induction and Intubation (RSII): Clinical Approach

Rapid Sequence Induction and Intubation (RSII): Clinical Approach Authors: Sandy Ly Reviewers: Wendy Yao Melinda Davis* * MD at time of publication Reversible with Sugammadex (selective relaxant binding agent) Responds to acetylcholinesterase Reversible with acetylcholinesterase inhibitors Not immediately reversible due to high dose Classical RSII Modified RSII Induction Agent e.g. Ketamine or Propofol (2 mg/kg) Inhibitory effect on central nervous system Cricoid pressure (10 lbs pressure posteriorly) Esophagus at the level of the cricoid obstructed Reduced gastric regurgitation Succinylcholine (2 mg/kg) acts similar to Ach Depolarize end plate nicotinic receptors in skeletal muscle Non-competitive with no antagonist Rapid skeletal muscle paralysis (<30 seconds) with short duration (<10 minutes) Irreversible Preoxygenation with 100% O2 displaces nitrogen. Functional residual capacity (2.5L) is filled with O2 Oxygen consumption (250 mL/min) Extend time to desaturation (Ideal condition: 10 minutes) Gastric distension with use of bag valve mask ventilation (positive pressure) High dose Rocuronium (1 mg/kg) competitively antagonizes Ach Decreased Ach binding on nicotinic receptors in skeletal muscle Rapid skeletal muscle paralysis (<60 seconds) with long duration (>45 minutes) Quick Facts Induction of anesthesia Abbreviations Ach – acetylcholine See other pathways for more detailed pathophysiology • • • RSII is used in patients with increased risk of gastric aspiration. Cricoid pressure is NOT THE SAME as BURP (backward, upward, rightward pressure). Other induction agents possible (e.g. etomidate). Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published September 22, 2019 on www.thecalgaryguide.com

Sugammadex

Sugammadex: Mechanism of action and adverse side effects A direct reversal agent with a high affinity for rocuronium and lesser affinity for vecuronium, capable of reversing even deep neuromuscular blockade. Binds rocuronium and vecuronium (non-depolarizing neuromuscular blocking drugs (nNMBs)) in plasma when administered IV ↓ Concentration of functional nNMBs in plasma Creates a concentration gradient from muscle tissue (high) to plasma (low) nNMBs move from muscle compartment to plasma Sugammadex in plasma encapsulates nNMBs that moved to the plasma ↓ Concentration of functional nNMBs in the plasma ↓ Concentration of nNMBs at the nicotinic acetylcholine receptor within the skeletal neuromuscular junction Reverses neuromuscular blockade created by nNMBs Sugammadex Progesterone is similar in structure to nNMBs Sugammadex binds progesterone ↓ Progesterone activity in the body Progesterone is critical for maintenance of early pregnancy Unknown significance, avoid use in early pregnancy Sugammadex-nNMB complex is cleared by the kidneys Higher concentrations of sugammadex facilitate faster nNMB clearance Unknown mechanisms Post operative nausea and vomiting Headache Bradycardia Cardiovascular Collapse ↓ Effectiveness of progesterone-based contraception for 7 days ↓ Clearance in patients with severe renal impairment Reversal of profoundly deep neuromuscular blockade at higher doses Binds to IgG or IgE receptors on sensitized basophils/mast cells in allergic reactions Activation of basophils/mast cells Degranulation of basophils/mast cells Release of granulation products Anaphylaxis Bronchospasm Hypotension Authors: Arzina Jaffer, Kayleigh Yang Reviewers: Jasleen Brar, Mao Ding Joseph Ahn* * MD at time of publication Movement of limbs or body during anesthesia Coughing during anesthesia Grimacing or suckling on the endotracheal tube Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published January 16, 2024 on www.thecalgaryguide.com