TY - JOUR
T1 - What is the Role of Sugammadex in the Emergency Department?
AU - Lentz, Skyler
AU - Morrissette, Katelin M.
AU - Porter, Blake A.
AU - DeWitt, Kyle M.
AU - Koyfman, Alex
AU - Long, Brit
N1 - Publisher Copyright:
© 2020
PY - 2021/1
Y1 - 2021/1
N2 - Background: Sugammadex is a medication newly available to many emergency physicians. It effectively, and within minutes, reverses neuromuscular blockade in patients who have received rocuronium or vecuronium. The role of sugammadex for the reversal of neuromuscular blockade after rapid sequence intubation in the emergency department (ED) is evolving, and limited emergency medicine-specific literature exists. Objective: This narrative review evaluates the role of sugammadex for the reversal of neuromuscular blockade in the ED. Discussion: The basic pharmacology, duration of action, adverse effects, and important medication and disease interactions specific to sugammadex are well described. Case reports suggest sugammadex can reverse neuromuscular blockade to facilitate an urgent, neurologic examination by an emergency physician or consultant. Multiple case reports of failure to improve airway patency with the use of sugammadex, even when neuromuscular blockade is completely reversed, and concern for added difficulty of definitive airway management in a patient with spontaneous movement suggest that sugammadex should largely be omitted from failed or difficult airway management strategies. Instead, it is important to focus on the ability to oxygenate and ventilate, including progression to surgical airway or jet ventilation if needed. Conclusion: Sugammadex is an effective, rapid reversal agent for rocuronium and has the potential use to facilitate an urgent neurologic examination shortly after administration of rocuronium. Its routine inclusion in a failed or difficult emergency airway is not supported by available literature.
AB - Background: Sugammadex is a medication newly available to many emergency physicians. It effectively, and within minutes, reverses neuromuscular blockade in patients who have received rocuronium or vecuronium. The role of sugammadex for the reversal of neuromuscular blockade after rapid sequence intubation in the emergency department (ED) is evolving, and limited emergency medicine-specific literature exists. Objective: This narrative review evaluates the role of sugammadex for the reversal of neuromuscular blockade in the ED. Discussion: The basic pharmacology, duration of action, adverse effects, and important medication and disease interactions specific to sugammadex are well described. Case reports suggest sugammadex can reverse neuromuscular blockade to facilitate an urgent, neurologic examination by an emergency physician or consultant. Multiple case reports of failure to improve airway patency with the use of sugammadex, even when neuromuscular blockade is completely reversed, and concern for added difficulty of definitive airway management in a patient with spontaneous movement suggest that sugammadex should largely be omitted from failed or difficult airway management strategies. Instead, it is important to focus on the ability to oxygenate and ventilate, including progression to surgical airway or jet ventilation if needed. Conclusion: Sugammadex is an effective, rapid reversal agent for rocuronium and has the potential use to facilitate an urgent neurologic examination shortly after administration of rocuronium. Its routine inclusion in a failed or difficult emergency airway is not supported by available literature.
KW - airway management
KW - neuromuscular blockade
KW - rapid sequence intubation
KW - rocuronium
KW - sugammadex
UR - http://www.scopus.com/inward/record.url?scp=85091244639&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85091244639&partnerID=8YFLogxK
U2 - 10.1016/j.jemermed.2020.08.006
DO - 10.1016/j.jemermed.2020.08.006
M3 - Article
C2 - 32962903
AN - SCOPUS:85091244639
SN - 0736-4679
VL - 60
SP - 44
EP - 53
JO - Journal of Emergency Medicine
JF - Journal of Emergency Medicine
IS - 1
ER -