Properities
sugammadex is a selective ____ ______ agent
selective relaxant binding agent with aminosteroids
major route of elimination
urine
what is considered a moderate block
spontaneous recovery of the second twitch, 2/4 twitches on TOF
side effects
dose related: pruritus, urticaria, N/V
marked bradycardia
doesnt work
anaphylactic
what is recururaization
a re-paralyzed patient
chemical structure/properties of sugammadex
gamma cyclodextrin
*dextrose units from starch
highly water soluble
how much sugammadex is eliminated in 6 hours
70%
dose of moderater block
2 mg/kg
if re-paralyzation is needed after 4 mg/kg of Sugammadex; what can be given after waiting 5 min
1.2 mg/kg ROC
PACU signs of recurarization
declining SaO2 and respiratory effort
*unresponsive
*appears floppy or uncoordinated
*ineffective abdominal and intercostal activity
MOA of sugammadex
intermolecular (van der waals) forces, thermodynamic (hydrogen) bonds, and hydrophobic interactions causing tight reversal by encapsulation
how much sugammadex is eliminated in 24 hours
90%
what is considered a deep block
0/4 twitches on TOF
1-2 post-tetanic counts
if re-paralyzation is needed after 4 mg/kg of Sugammadex; what can be given after waiting4 hours
0.6 mg/kg roc
0.1 mg/kgvec
signs and symptoms of recurarization
verbalize: suffocating feeling
unable to sustain head lift or hand grasp
pharyngeal collapse and respiratory obstruction
which aminosteroids can sugammadex bind
Rocuronium > Vecuronium >> Pancuronium
CI to sugammadex
renal impairment with dialysis
dose for deep block
4 mg/kg
if neuromuscular blockade is required before 4 hours, or you dont want to give 1.2 mg/kg ROC what can you do
Give a benzolysiquinolone
treatment goal with recurarization
give additional reversal agents in divided doses
what does sugammadex bind to
free drug in plasma
elimination half life of sugammadex
2 hours
extreme block dose
8-16 mg/kg
cautions with sugammadex
oral contraceptives: binds with progesterone (7 days)
toremifene (non-steroid anti-estrogen) displaces NMBD from sugammadex
coagulopathy/bleeding: on Heparin/LMWH elevated PTT, PT, INR
DOC for recuraization
neostigmine 0.05 mg/kg IV
longer duration of action (60 min)