Thomas M Hemmerling1, Cedrick Zaouter1, Goetz Geldner2, Dirk Nauheimer2
1 Department of Anesthesia, McGill University, Montreal, Canada
2 Department of Anesthesia, Ludwigsburg Hospital, University Heidelberg, Germany
This review outlines the basic pharmacodynamic and pharmacokinetic properties of sugammadex for the cardiac anesthesiologist. It describes the different clinical scenarios when sugammadex can be used during cardiac surgery and gives clinical recommendations. Sugammadex is a unique reversal drug that binds a chemical complex with rocuronium and vecuronium, by which the neuromuscular blockade is quickly reversed. It is free of any clinical side-effects and doses of 2 mg/kg or more reliably reverse neuromuscular blockade within 5-15 min, depending on the depth of the neuromuscular blockade. Doses below 2 mg/kg should be avoided at any time because of the inherent risk of recurarization. Sugammadex should not replace good clinical practice - titration of neuromuscular blocking drugs to clinical needs and objective monitoring of neuromuscular blockade in the operating room or intensive care unit. Neuromuscular transmission should be determined in all patients before sugammadex is considered and 5 min after its administration to ensure that extubation is performed with normal neuromuscular transmission.
Thomas M Hemmerling
NRG Laboratory, Montreal General Hospital, 1650 Cedar Avenue, Montreal, H3G 1B7
Source of Support: None, Conflict of Interest: None
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