Anaes Vivas · Neuromuscular blockade & reversal
Clinical viva — sugammadex dosing by depth of block
A clinical viva on sugammadex dosing — the three depth-matched doses (2 mg/kg for a moderate block, 4 mg/kg for a deep block, 16 mg/kg for immediate reversal of a 1.2 mg/kg intubating dose), the monitoring that determines the depth, and the constraints (rocuronium/vecuronium only; renal excretion). Anchored to the Cochrane review.
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Target exams
ANZCAFRCAABAEDAIC
Prompt
A patient is reversed from a rocuronium block of varying depth. The examiner asks you to talk through how you choose the dose of sugammadex.
Stimulus
A patient under a rocuronium neuromuscular block needs reversal. Talk through how you choose the dose of sugammadex, the monitoring that informs it, and the constraints on its use.
References3ShowHide
- [2]Hristovska AM, Duch P, Allingstrup M, Afshari A. Efficacy and safety of sugammadex versus neostigmine in reversing neuromuscular blockade in adults. Cochrane Database of Systematic Reviews, 2017.PMID 28806470
- [1]Gijsenbergh F, Ramael S, Houwing N, van Iersel T. First human exposure of Org 25969, a novel agent to reverse the action of rocuronium bromide. Anesthesiology, 2005.PMID 16192761
- [3]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.