Abstract:
BACKGROUND:Sugammadex, a γ-cyclodextrin derivative, belongs to a new class of selective relaxant binding agents. Sugammadex was approved 10-years ago by the European medicines agency and today is used in clinical anesthesia and emergency medicine globally. In this review, indications for neuromuscular block, the challenge of neuromuscular monitoring and the practice of under-dosing of sugammadex as a potential cost-saving strategy are discussed. MAIN BODY:Reversal of neuromuscular block is important to accelerate the spontaneous recovery of neuromuscular function. Sugammadex is able to reverse a rocuronium- or vecuronium-induced neuromuscular block rapidly and efficiently from every depth of neuromuscular block. However, since sugammadex was introduced in clinical anesthesia, several studies have reported administration of a lower-than-recommended dose of sugammadex. The decision to under-dose sugammadex is often motivated by cost reduction concerns, as the price of sugammadex is much higher than that of neostigmine outside the United States. However, under-dosing of sugammadex leads to an increased risk of recurrence of neuromuscular block after an initial successful (but transient) reversal. Similarly, when not using objective neuromuscular monitoring, under-dosing of sugammadex may result in residual neuromuscular block in the postoperative care unit, with its attendant negative pulmonary outcomes. Therefore, an appropriate dose of sugammadex, based on objective determination of the depth of neuromuscular block, should be administered to avoid residual or recurrent neuromuscular block and attendant postoperative complications. Whether the reduction in perioperative recovery time of the patient can be translated into additional procedural cases performed, faster operative turnover times, or improved organizational resource utilization, has yet to be determined in actual clinical practice that includes verification of neuromuscular recovery prior to tracheal extubation. CONCLUSIONS:The current review addresses the indications for neuromuscular block, the challenge of neuromuscular monitoring, the practice of under-dosing of sugammadex as a potential cost-saving strategy in reversal of deep neuromuscular block, the economics of sugammadex administration and the potential healthcare cost-saving strategies.
journal_name
BMC Anesthesioljournal_title
BMC anesthesiologyauthors
de Boer HD,Carlos RV,Brull SJdoi
10.1186/s12871-018-0605-6subject
Has Abstractpub_date
2018-11-06 00:00:00pages
159issue
1issn
1471-2253pii
10.1186/s12871-018-0605-6journal_volume
18pub_type
杂志文章,评审abstract:BACKGROUND:Data on the best norepinephrine bolus dose for management of hypotension are limited. The aim of this study was to compare the efficacy and safety of two norepinephrine bolus doses in the rescue management of maternal hypotension during cesarean delivery. METHODS:This randomized, controlled trial included m...
journal_title:BMC anesthesiology
pub_type: 杂志文章
doi:10.1186/s12871-020-01004-y
更新日期:2020-04-17 00:00:00
abstract:BACKGROUND:Spinal block is a common procedure for lower limbs surgery. Fentanyl, a synthetic opioid and dexmedetomidine, a selective α2 agonist have been used as adjuvants in spinal anesthesia to prolong intraoperative and postoperative analgesia. The aim of current study is to compare the efficacy of dexmedetomidine a...
journal_title:BMC anesthesiology
pub_type: 杂志文章,随机对照试验
doi:10.1186/s12871-018-0531-7
更新日期:2018-06-06 00:00:00
abstract:BACKGROUND:Many cases of coronary artery spasm (CAS) during general plus epidural anesthesia have been reported. But transversus abdominis plane(TAP) block in combination with general anesthesia has not been reported to be a cause of CAS, let alone a life-threatening CAS. CASE PRESENTATION:In this case report, we pres...
journal_title:BMC anesthesiology
pub_type: 杂志文章
doi:10.1186/s12871-018-0616-3
更新日期:2018-10-20 00:00:00
abstract:BACKGROUND:Since blood pressure tends to be unstable during induction of anesthesia in patients undergoing cardiovascular surgery, an artery catheter is often inserted before induction to continuously monitor arterial pressure during induction of anesthesia. ClearSight System™ enables noninvasive continuous measurement...
journal_title:BMC anesthesiology
pub_type: 杂志文章
doi:10.1186/s12871-020-01091-x
更新日期:2020-07-20 00:00:00
abstract:BACKGROUND:Obstetric dfficult airway is a leading cause of maternal morbidity and mortality. The laryngeal mask airway (LMA) is often used as a rescue airway device after failed intubation, however, little is known about predictors of difficult LMA insertion, particularly in obstetrics. Since Mallampati scores of III/I...
journal_title:BMC anesthesiology
pub_type: 临床试验,杂志文章
doi:10.1186/s12871-019-0796-5
更新日期:2019-07-08 00:00:00
abstract:BACKGROUND:Embolic stroke is a common complication of atrial myxoma, whereas multiple cerebral aneurysms associated with atrial myxoma is rare. The pathogenesis of the cerebral vascular disease related to an atrial myxoma is still not well known, and there are no guidelines to guide treatment and anesthesia management ...
journal_title:BMC anesthesiology
pub_type: 杂志文章
doi:10.1186/s12871-020-01055-1
更新日期:2020-07-04 00:00:00
abstract:BACKGROUND:This study investigated the effect of different degrees of passive leg raising (PLR) on the internal jugular vein (IJV) cross-sectional area (CSA) and on the success rate of IJV cannulation in patients waiting for thoracic surgery, to analyze whether body mass index (BMI), gender, age, fasting time and preop...
journal_title:BMC anesthesiology
pub_type: 杂志文章,随机对照试验
doi:10.1186/s12871-019-0751-5
更新日期:2019-05-17 00:00:00
abstract:BACKGROUND:Endotracheal extubation is the most crucial step during emergence from general anesthesia and is usually carried out when patients are awake with return of airway reflexes. Alternatively, extubations can also be accomplished while patients are deeply anesthetized, a technique known as "deep extubation", in o...
journal_title:BMC anesthesiology
pub_type: 杂志文章
doi:10.1186/s12871-020-01191-8
更新日期:2020-10-29 00:00:00
abstract:BACKGROUND:Laryngeal mask airway is a supraglottic airway device which has led to a fundamental change in the management of modern general anesthesia. In the present study; we evaluated the laryngeal mask airway insertion conditions and hemodynamic changes comparing ketamine-propofol mixture (ketofol) with propofol. Th...
journal_title:BMC anesthesiology
pub_type: 杂志文章
doi:10.1186/s12871-019-0711-0
更新日期:2019-03-20 00:00:00
abstract:BACKGROUND:Sugammadex is a modified gamma-cyclodextrin that acts by selectively encapsulating free amino-steroidal neuromuscular relaxants. Several case reports have been published on the use of sugammadex in patients with neuromuscular disorders that include neuromuscular junction diseases, myopathies, neuropathies, a...
journal_title:BMC anesthesiology
pub_type: 杂志文章
doi:10.1186/s12871-019-0887-3
更新日期:2019-11-19 00:00:00
abstract:BACKGROUND:There are growing concerns that anaesthetic exposure can cause extensive apoptotic degeneration of neurons and the impairment of normal synaptic development and remodelling. However, little attention has been paid to exploring the possible cytotoxicity of inhalation anaesthetics, such as isoflurane, in astro...
journal_title:BMC anesthesiology
pub_type: 杂志文章
doi:10.1186/s12871-017-0420-5
更新日期:2017-09-05 00:00:00
abstract:BACKGROUND:Splenectomy performed with a curved incision results in severe postoperative pain. The aim of this study was to evaluate the effect of transversus abdominis plane block and rectus sheath block on postoperative pain relief and recovery. METHODS:A total of 150 patients were randomized into the control (C), le...
journal_title:BMC anesthesiology
pub_type: 杂志文章,随机对照试验
doi:10.1186/s12871-020-0941-1
更新日期:2020-01-23 00:00:00
abstract:BACKGROUND:To determine whether continuous intravenous infusion of dexmedetomidine (DEX) can affect the incidence of Emergence Agitation (EA) after general anesthesia in infant undergoing cleft palate repair surgery. METHODS:Forty infants underwent cleft palate repair surgery under general anesthesia were randomly div...
journal_title:BMC anesthesiology
pub_type: 杂志文章,随机对照试验
doi:10.1186/s12871-015-0124-7
更新日期:2015-10-13 00:00:00
abstract:BACKGROUND:It has been hypothesized that dexamethasone can inhibit persistent postoperative pain, but data on humans is lacking and results from animal studies are conflicting. We explored the effect of 16 mg dexamethasone IV administered preoperatively on persistent pain 1 year after lumbar discectomy. METHODS:This i...
journal_title:BMC anesthesiology
pub_type: 杂志文章,随机对照试验
doi:10.1186/s12871-016-0277-z
更新日期:2016-11-16 00:00:00
abstract:BACKGROUND:Tracheostomy is recommended for patients receiving mechanical ventilation (MV) for 14 days or more in the intensive care unit (ICU). Nevertheless, many patients undergoing prolonged MV remain intubated via the translaryngeal route. The aim of this study was to examine the influence of tracheostomy and persis...
journal_title:BMC anesthesiology
pub_type: 杂志文章
doi:10.1186/s12871-015-0159-9
更新日期:2015-12-15 00:00:00
abstract:BACKGROUND:Perioperative hemodynamic fluctuations are seen more often in hypertensive patients than in normotensive patients. The purpose of our study was to investigate the perioperative hemodynamic effects of dexmedetomidine and midazolam used for premedication in hypertensive patients relative to each other and in c...
journal_title:BMC anesthesiology
pub_type: 杂志文章,随机对照试验
doi:10.1186/1471-2253-14-113
更新日期:2014-12-10 00:00:00
abstract::We have developed a two-step procedure for preparing the skin before peripheral venous catheter (PVC) insertions. This procedure involves two successive swabbings with wipes soaked in alcoholic antiseptic. We investigated whether this two-step procedure was as effective and safe as the standard four-step procedure--wa...
journal_title:BMC anesthesiology
pub_type: 杂志文章
doi:10.1186/1471-2253-7-1
更新日期:2007-01-31 00:00:00
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journal_title:BMC anesthesiology
pub_type: 杂志文章
doi:10.1186/s12871-016-0264-4
更新日期:2016-10-14 00:00:00
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journal_title:BMC anesthesiology
pub_type: 杂志文章
doi:10.1186/s12871-019-0852-1
更新日期:2019-10-09 00:00:00
abstract:BACKGROUND:Low-flow sevoflurane anesthesia has been shown to influence renal function in rats, but not in adult humans. Presently, no study has assessed the effects of sevoflurane on renal function in low birth weight infants. Our aim was to study the renal function in low birth weight infants undergoing surgery with l...
journal_title:BMC anesthesiology
pub_type: 杂志文章
doi:10.1186/1471-2253-15-6
更新日期:2015-01-21 00:00:00
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pub_type: 杂志文章
doi:10.1186/s12871-019-0693-y
更新日期:2019-02-23 00:00:00
abstract:BACKGROUND:Goal-directed fluid therapy (GDFT) based on dynamic indicators of fluid responsiveness has been shown to decrease postoperative complications and hospital length of stay (LOS) in patients undergoing major abdominal surgery. The usefulness of this approach still needs to be clarified in low-to-moderate risk a...
journal_title:BMC anesthesiology
pub_type: 杂志文章,随机对照试验
doi:10.1186/s12871-019-0707-9
更新日期:2019-03-09 00:00:00
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journal_title:BMC anesthesiology
pub_type: 杂志文章
doi:10.1186/1471-2253-12-2
更新日期:2012-02-01 00:00:00
abstract:BACKGROUND:The α2-adrenergic agonist dexmedetomidine (DEX) is a sedative and can be used as an adjunct to hypnotics. The study sought to evaluate the effects of different doses of DEX on the requirements for propofol for loss of consciousness (LOC) in patients monitored via the bispectral index (BIS). METHODS:In this ...
journal_title:BMC anesthesiology
pub_type: 杂志文章
doi:10.1186/s12871-020-01013-x
更新日期:2020-04-25 00:00:00
abstract:BACKGROUND:Pierre Robin Sequence (PRS) patients are known for their triad of micrognathia, glossoptosis, and airway obstruction. Their airway can be a challenge even for the most experienced pediatric anesthesiologist. CASE PRESENTATION:We report the case of a 9 day old 3.5 kg boy diagnosed with PRS, cleft palate, and...
journal_title:BMC anesthesiology
pub_type: 杂志文章
doi:10.1186/s12871-019-0754-2
更新日期:2019-05-22 00:00:00
abstract:BACKGROUND:Endotracheal intubation of patients with massive regurgitation represents a challenge in emergency airway management. Gastric contents tend to block suction catheters, and few treatment alternatives exist. Based on a technique that was successfully applied in our district, we wanted to examine if endotrachea...
journal_title:BMC anesthesiology
pub_type: 杂志文章,随机对照试验
doi:10.1186/s12871-018-0474-z
更新日期:2018-01-18 00:00:00
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journal_title:BMC anesthesiology
pub_type: 杂志文章
doi:10.1186/s12871-018-0644-z
更新日期:2018-12-03 00:00:00
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journal_title:BMC anesthesiology
pub_type: 杂志文章,meta分析
doi:10.1186/s12871-018-0635-0
更新日期:2018-11-13 00:00:00
abstract:BACKGROUND:Quadratus lumborum block (QLB) is an effective analgesia that lowers opioid consumption after lower abdominal and hip surgeries. The subcostal approach to transmuscular QLB is a novel technique that can provide postoperative analgesia by blocking more dermatomes. The aim of this study is to evaluate the effi...
journal_title:BMC anesthesiology
pub_type: 杂志文章,随机对照试验
doi:10.1186/s12871-019-0825-4
更新日期:2019-08-14 00:00:00
abstract:BACKGROUND:There is no defined gold standard for pain management after video-assisted thoracic surgery (VATS) for pneumothorax. In addition to systemic analgesia, various loco-regional analgesic techniques have been proposed but remain poorly evaluated in this context. We aimed to assess the analgesic efficacy of sever...
journal_title:BMC anesthesiology
pub_type: 杂志文章
doi:10.1186/s12871-019-0797-4
更新日期:2019-07-06 00:00:00