Clinical Case Database / Category: Patient Management
Mechanism of action, monitoring & reversal of neuromuscular blocking agents: the use of Sugammadex
Publication details
Dr T Jacobs, MV Copp
Foundation Years Journal, volume 9, issue 8, p.45 (123Doc Education, London, September 2015)
Abstract
The classical triad of anaesthesia consists of hypnosis, analgesia and muscle relaxation. The introduction of neuromuscular blocking drugs (NMB) in the 1940's transformed the way in which anaesthesia could be safely delivered to patients. The NMB drugs provided the ability to paralyze patients to facilitate intubation of the trachea and provide muscle relaxation during major surgery. The NMB drugs work by occupying nicotinic Acetylcholine receptors (nAchR) in a competitive antagonism with endogenous acetylcholine (Ach) at the neuromuscular junction. At the end of surgery muscle paralysis usually needs to be reversed by the administration of anticholinesterase drugs such as Neostigmine. These drugs have known side effects which can give rise to problems in some patients. A new novel drug called Sugammadex has been introduced into anaesthetic clinical practice which has a completely different mechanism of action to reverse NMB drugs. It brings significant safety benefits for some patients. Its drawback is that it is expensive. In this article we will overview the role and mechanism of action of NMB drugs, including reversal, and will highlight some specific indications for Sugammadex.
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Authors
Dr T Jacobs (Corresponding author)
ST5 in Anaesthesia Severn Deanery
Department of Anaesthesia
Cheltenham General Hospital
Cheltenham, GL52 3BS
tobyjacobs@doctors.net.uk
MV Copp
Consultant Anaesthetist
Gloucestershire Hospitals NHSFT
Department of Anaesthesia
Cheltenham General Hospital
Cheltenham, GL52 3BS
michael.copp@glos.nhs.uk
References
1. Jonas Appiah-Ankam and Jennifer M Hunter. Pharmacology of neuromuscular blocking drugs. Contin Educ Anaesth Crit Care Pain (2004) 4 (1): 2-7
2. Ali HH, Utting JE, Gray TC. Stimulus frequency in the detection of neuromuscular block in humans. Brit. J. Anaesth. 1970; 42: 967–78
3. M. Naguib, A.F.Kopman, J.E.Ensor. Neuromuscular monitoring and postoperative residual curarisation: a meta-analysis. Br. J. Anaesth. (2007) 98 (3): 302-316
4. Murphy, Glenn S.; Brull, Sorin J. Residual Neuromuscular Block: Lessons Unlearned. Part I: Definitions, Incidence, and Adverse Physiologic Effects of Residual Neuromuscular Block. Anesthesia & Analgesia. July (2010) 111 (1):120-128
5. Bom A, Hope F, Rutherford S, Thomson K. Preclinical pharmacology of sugammadex. J Crit Care. 2009; 24: 29-35.
6. Martini CH, Boon M, Bevers RF, Aarts LP, Dahan A. Evaluation of surgical conditions during laparoscopic surgery in patients with moderate vs deep neuromuscular block. Br J Anaesth. 2014; 112: 498-505.
7. Lee C, Jahr JS, CandiottKA, Warriner B, Zornow MH, Naguib M. Reversal of profound neuromuscular block by sugammadex administered three minutes after rocuronium. Anesthesiology. 2009; 110:1020-5
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The Foundation Years Clinical Cases Database is a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.
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