Clinical implications of new neuromuscular concepts and agents:☆
So long, neostigmine! So long, sux!
Abstract
Although antiquated and long targeted for obsolescence, neostigmine and succinylcholine still serve the anesthesia community, decades after their inferior pharmacological profiles have been recognized. The need to quickly establish a good intubation condition with a relaxant that will recover rapidly is fundamental to safe anesthesia practice. So is the need to restore muscle power safely and quickly at the end of surgery, by reversing a residual neuromuscular block. Recent data have shown that sugammadex can safely and rapidly reverse profound neuromuscular block established by rocuronium and vecuronium. This allows for use of rocuronium to establish a good intubation condition, and use of sugammadex to terminate the neuromuscular block at will. The present article assesses the clinical implications of such therapeutic regimen, and provides an educated guess on how the clinical neuromuscular practice might change, if and when sugammadex becomesclinically available.
Keywords: Neostigmine, Succinylcholine, Sugammadex, Neuromuscular block, Neuromuscular reversal
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☆ The authors have in the past received supports for their neuromuscular researches from various sponsors including Organon, USA, Inc, now a part of Schering-Plough Corporation, owner of sugammadex. One author (CL) is coprincipal investigator and coinventor of the TAAC3 series of compounds (now deactivated) cited in the text as reference 8, which was in the past sponsored in part by said sponsor. He is also principal investigator of a multicenter study on sugammadex, cited as reference 4, which was also sponsored by the same sponsor.
PII: S0883-9441(08)00191-3
doi:10.1016/j.jcrc.2008.08.009
© 2009 Published by Elsevier Inc.
