الفهرس | Only 14 pages are availabe for public view |
Abstract The use of muscle relaxant is not only revolutionized the practice of anesthesia but also started the modem era of surgery and made possible the explosive development of cardiothoracic, neurologic and organ transplantation. Currently, only succinylcholine, a depolarizing short acting muscle relaxant with a high degree of side effects, allows anesthetists to quickly control the airway and intubate the trachea without the risk of extended paralysis should ventilation or intubation become difficult. The duration of action of all currently available nondepolarizing muscle relaxants is too long if an anesthesiologist is faced with a short case or an unexpected cannot intubate, cannot ventilate scenario. The inability of cholinesterase inhibitors to reverse a profound nondepolarizing blockade may be one important reason for the unrelenting persistence of succinylcholine in current anesthetic practice, in particular for its two principal indications, relaxation for rapid sequence induction and ultra short procedures. Rocuronium, a non-depolarizing NMBA, at doses of 1.2 mglkg and higher allows quick onset and rapid sequence intubation ability with minimal side effects, the reluctance to use rocuronium is due to its extended duration of neuromuscular blockade. An ideal reversal agent should, among other things, facilitate rapid and complete reversal of any level of neuromuscular blockade (NMB), even profound blockade, at any time, and should be devoid of muscarinic effects. To fulfill these criteria, a new concept for the reversal ofNMB has been developed, sugammadex, a water-soluble, modified cyclodextrin, was selected for clinical development it rapidly reverses rocuronium- induced NMB by encapsulating the unbound rocuronium molecules, thereby enhancing the transfer of rocuronium from the effect compartment. Sugammadex is expected to provide the ability to rapidly terminate rocuronium-induced paralysis , and restore motor function and spontaneous ventilation should intubation fail. Sugammadex termination of rocuronium’s effects is faster than succinylcholine degradation by plasma enzymes (at the appropriate dose) and may provide another option for rapid sequence intubations. |