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001-es BibID:BIBFORM077685
035-os BibID:(WoS)000450430400024 (Scopus)85056649292
Első szerző:Tassonyi Edömér (aneszteziológus)
Cím:Reversal of Deep Pipecuronium-Induced Neuromuscular Block With Moderate Versus Standard Dose of Sugammadex : a Randomized, Double-Blind, Noninferiority Trial / Edömér Tassonyi, László Asztalos, Zoltán Szabó-Maák, Réka Nemes, Adrienn Pongrácz, Szabolcs Lengyel, Béla Fülesdi
Dátum:2018
ISSN:0003-2999
Megjegyzések:BACKGROUND: Certain surgical interventions may require a deep neuromuscular block (NMB). Reversal of such a block before tracheal extubation is challenging. Because anticholinesterases are ineffective in deep block, sugammadex 4 mg/kg has been recommended for the reversal of rocuronium- or vecuronium-induced deep NMB. However, this recommendation requires opening 2 vials of 200 mg sugammadex, which results in an increase in drug costs. Therefore, we sought a less expensive solution for the induction and reversal of deep NMB. Although the optimal dose of sugammadex for antagonism of deep block from pipecuronium has not been established, data pertaining to moderate block are available. Accordingly, we hypothesized that sugammadex 2 mg/kg would be a proper dose to reverse deep pipecuronium block, enabling us to avoid cost increases. In the present study, we compared sugammadex 2 mg/kg with the standard dose of 4 mg/kg for reversal of deep block from pipecuronium. METHODS: This single-center, randomized, double-blind, 2 parallel-arms, noninferiority study comprised 50 patients undergoing general anesthesia with propofol, sevoflurane, fentanyl, and pipecuronium. Neuromuscular monitoring was performed with acceleromyography (TOF-Watch SX). Noninferiority margin was specified beforehand as an increase in reversal time of no >10% (corresponding to 1 minute for the primary outcome). When the block spontaneously recovered to posttetanic count 1, the patients randomly received sugammadex 2 or 4 mg/kg, and the time from the injection to the train-offour (TOF) ratio of 1.0 was measured. Primary outcome was the time to achieve the normalized TOF ratio of 0.9 in a particular patient. Residual or recurrent postoperative NMB was additional end point. RESULTS: Each patient recovered to the normalized TOF ratio of 0.9. In the 2 mg/kg group, reversal time was 1.73 ? 1.03 minutes (95% confidence interval [CI], 1.33?2.13; n = 25), and in the 4 mg/kg group, reversal time was 1.42 ? 0.63 minutes (mean ? standard deviation) (95% CI, 1.17?1.67; n = 25). The mean difference in reversal times between the 2 groups was 0.31 minutes (95% CI, ?0.18 to 0.8), and the upper limit of CI was below the noninferiority margin of 1 minute. Postoperative block did not occur. CONCLUSIONS: The effect of sugammadex 2 mg/kg was noninferior to that of 4 mg/kg in reversing posttetanic count-1 degree pipecuronium block. Sugammadex reversal of deep pipecuronium block appears to be effective. (Anesth Analg 2018;127:1344?50)
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
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Megjelenés:Anesthesia And Analgesia. - 127 : 6 (2018), p. 1344-1350. -
További szerzők:Asztalos László (1985-) (aneszteziológus) Szabó-Maák Zoltán (1984-) (aneszteziológus, intenzív terápiás szakorvos) Nemes Réka (1985-) (aneszteziológus, intenzív terápiás szakorvos) Pongrácz Adrienn (1971-) (aneszteziológus, intenzív terápiás szakorvos) Lengyel Szabolcs (1971-) (biológus) Fülesdi Béla (1961-) (aneszteziológus)
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001-es BibID:BIBFORM060544
Első szerző:Tassonyi Edömér (aneszteziológus)
Cím:Reversal of Pipecuronium-Induced Moderate Neuromuscular Block with Sugammadex in the Presence of a Sevoflurane Anesthetic / Edömér Tassonyi, Adrienn Pongrácz, Réka Nemes, László Asztalos, Szabolcs Lengyel, Béla Fülesdi
Dátum:2015
ISSN:0003-2999
Megjegyzések:BACKGROUND:Pipecuronium is a steroidal neuromuscular blocking agent. Sugammadex, a relaxant binding ?-cyclodextrin derivative, reverses the effect of rocuronium, vecuronium, and pancuronium. We investigated whether sugammadex reverses moderate pipecuronium-induced neuromuscular blockade (NMB) and the doses required to achieve reversal.METHODS:This single-center, randomized, double-blind, 5-group parallel-arm study comprised 50 patients undergoing general anesthesia with propofol, sevoflurane, fentanyl, and pipecuronium. Neuromuscular monitoring was performed with acceleromyography (TOF-Watch SX) according to international standards. When the NMB recovered spontaneously to train-of-four count 2, patients randomly received 1.0, 2.0, 3.0, or 4.0 mg/kg of sugammadex or placebo. Recovery time from sugammadex injection to normalized train-of-four (TOF) ratio 0.9 was the primary outcome variable. The recovery time from the sugammadex injection to final T1 was the secondary end point. Postoperative neuromuscular functions were also assessed.RESULTS:Each patient who received sugammadex recovered to a normalized TOF ratio of 0.9 within 5.0 minutes (95% lower confidence interval for the lowest dose 70.1%; for all doses 90.8%) and 79% of these patients reached a normalized TOF ratio 0.9 within 2.0 minutes (95% lower confidence interval for the lowest dose 26.7%; for all doses 63.7%). T1 recovered several minutes after the TOF ratio. No residual postoperative NMB was observed.CONCLUSIONS:Sugammadex adequately and rapidly reverses pipecuronium-induced moderate NMB during sevoflurane anesthesia. Once the train-of-four count has spontaneously returned to 2 responses following pipecuronium administration, a dose of 2.0 mg/kg of sugammadex is sufficient to reverse the NMB.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
Megjelenés:Anesthesia And Analgesia. - 121 : 2 (2015), p. 373-380. -
További szerzők:Pongrácz Adrienn (1971-) (aneszteziológus, intenzív terápiás szakorvos) Nemes Réka (1985-) (aneszteziológus, intenzív terápiás szakorvos) Asztalos László (1985-) (aneszteziológus) Lengyel Szabolcs (1971-) (biológus) Fülesdi Béla (1961-) (aneszteziológus)
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