Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2014.10.001
Brazilian Journal of Anesthesiology
Scientific Article

Use of sugammadex on burn patients: descriptive study

Uso de sugamadex no paciente queimado: estudo descritivo

Eduardo Rodríguez Sánchez M.; Concepción Martínez Torres; Pablo Herrera Calo; Ignacio Jiménez

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Abstract

OBJECTIVES:: A burn patient is a challenge for any anesthesiologist, undergoing several surgeries during admission, and requiring general anesthesia and muscle relaxation most of the times. The victim may have respiratory system impairment and a response to muscle relaxants that differs from the healthy patient, thus proper monitoring and reversal is crucial. We analyzed sugammadex effectiveness and safety in this population.

MATERIALS AND METHODS:: It was a prospectively descriptive study, including 4 patients, and all of them were considered major burn patients, who underwent escharotomy with general anesthesia and neuromuscular relaxation. The main variable was the time for recovery of a TOF higher than 0.9 after the administration of sugammadex before extubation.

RESULTS:: Mean time of recovery from a TOF ratio higher than 0.9 following the administration of Sugammadex was of 4.95 min 95% CI (3.25-6.64, p= .53).

CONCLUSIONS:: The reversion of neuromuscular relaxation with sugammadex appears to be effective and safe in the burn patient. More analytical, comparative studies of larger populations would be necessary to confirm these data.

Keywords

Sugammadex, Cyclodextrin, Burn injury, Rocuronium, Neuromuscular block, Neostigmine

Resumo

OBJETIVOS:: O paciente queimado representa um desafio para o anestesiologista, pois se submete a várias intervenções cirúrgicas durante sua hospitalização e necessita de anestesia geral e relaxamento muscular na maior parte delas. Apresenta sistema respiratório comprometido e uma resposta aos relaxantes musculares que difere do paciente sadio; portanto, um monitoramento correto e reversão tornam-se imprescindíveis. Avaliamos a eficácia e segurança do sugamadex nessa população.

MATERIAL E MÉTODOS:: Estudo descritivo com caráter prospectivo que inclui quatro pacientes, todos eles considerados grandes queimados, submetidos a escarectomia com anestesia geral e relaxamento neuromuscular. Como variável principal tomou-se o tempo de recuperação de TOF superior a 0,9 após a administração de sugamadex antes de extubação.

RESULTADOS:: O tempo médio de recuperação de uma razão TOF superior a 0,9 após a administração de sugamadex foi de 4,95 minutos (IC95% 3,25-6,64; p = 0,53).

CONCLUSÕES:: A reversão do relaxamento neuromuscular com sugamadex parece ser eficaz e segura no paciente queimado. Seriam necessários mais estudos analíticos, comparativos e de maior população para confirmar esses dados.

Palavras-chave

Sugamadex, Gama-ciclodextrinas, Queimaduras, Androstanóis, Bloqueio neuromuscular, Neostigmina

References

Latenser BA. Critical care of the burn patient: the first 48 hours. Crit Care Med.. 2009;37:2819-26.

Steinvall I, Fredrikson M, Bak Z. Mortality after thermal injury: no sex-related difference. J Trauma.. 2011;70:959-64.

Brusselaers N, Monstrey S, Vogelaers D. Severe burn injury in Europe: a systematic review of the incidence, etiology, mor- bidity, and mortality. Crit Care.. 2010;14:R188.

Zhang MQ. Drug-specific cyclodextrins: the future of rapid neu- romuscular block reversal?. Drugs Fut.. 2003;99:632-7.

Bom A, Bradley M, Cameron K, Clark K, Van Egmond J, Feil- den H. A novel concept of reversing neuromuscular block: chemical encapsulation of rocuronium bromide by a cyclodextrin-based synthetic host. Angew Chem Int Ed Engl.. 2002;41:266-70.

Duvldestin P, Kuizenga K, Saldien V. A randomized, dose-response study of sugammadex given for the reversal of deep rocuronium-or vecuronium induced neuromuscular blockade under sevoflurane anesthesia. Anesth Analg.. 2010;110:74-82.

Suy K, Morias K, Cammu G. Effective reversal of mode- rate rocuronium or vecuronium-induced neuromuscular block whit sugammadex, a selective relaxant binding agent. Anesthe- siology.. 2007;106:283-8.

Jones RK, Caldwell F E, Brull SJ. Reversal of profound rocuronium-induced blockade at extubation: a randomized comparison whit neostigmine. Anesthesiology.. 2008;109:816-24.

Khuenl-Brady KS, Wattwil M, Vanacker BF. Sugammadex provides faster reversal of vecuronium-induced neuromuscular blockade compared with neostigmine: a multicenter, randomi- zed, controlled trial. Anesth Analg.. 2010;110:64-73.

Paton F, Paulden M, Chambers D. Sugammadex pro- vided significantly faster reversal of vecuronium-induced neuromuscular blockade compared with neostigmine. Br J Ana- esth.. 2010;105:558-67.

Plaud B, Meretoja O, Hofmockel R. Reversal of rocuronium-induced neuromuscular blockade with sugamma- dex in pediatric and adult surgical patients. Anesthesiology.. 2009;110:284-94.

Cantal E, Gouturbe P, Asencio Y. Reanimation et anesthesie du brule la´dulte. 2008.

Gasca PJD. Anestesia en el paciente quemado. Rev Mex Anest.. 2013;36:327-30.

Plaud B, Debaene B, Donati F. Residual paralysis after emergence from anesthesia. Anesthesiology.. 2010;112:1013-22.

Blobner M, Eriksson LI, Scholz J. Reversal of rocu- ronium induced neuromuscular blockade with sugammadex compared with neostigmine during sevoflurane anaesthesia: results of a randomised, controlled trial. Eur J Anaesthesiol.. 2010;27:874-81.

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