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In this episode I welcome Dr. Amit Prabhakar, one of our critical care fellows, to the show to discuss Sugammadex, a relatively recently approved (in the USA) reversal agent for Rocuronium and Vecuronium.
CME: https://earnc.me/h9cIdh
Outline by Brian Park: Sugammadex outline
As always, fantastic talk! The approval of Sugammadex is indeed an exciting development in anesthesia! There is a concept that I think is important to keep in mind: One of the uses for which Suggamadex is being touted, is the emergent reversal of neuromuscular blockade. Naturally, this is often thought of in the context of a difficult airway scenario, for a patient who has been paralyzed with rocuronium, and then can’t be ventilated or intubated. What is important to remember, is that one’s choice of induction agent, namely propofol, especially in combination with benzodiazepines and opioids, can produce apnea of a duration that may easily extend beyond the time of when neuromuscular blockade has been reversed. Therefore, it might still be necessary to continue to the next step in the difficult airway algorithm even with successful reversal by Sugammadex.
Great point Stephen. You’re absolutely right. Usually propofol alone will not cause apnea for more than 3-4 minutes but if given in combination with benzodiazepines and/or opioids it definitely can. Thanks for listening and thanks for your always astute comments!
Great discussion! I’m interested in reading the randomized control trial that Dr. Prabhakar was referring to about Sugammadex vs Neostigmine. Are you able to provide me with name of the article?
Hi Mary, I’m not sure exactly which article, but here is a recent cochrane review that addresses the same question: https://www.ncbi.nlm.nih.gov/pubmed/28806470