Sugammadex cleared by FDA.

[G0S2]

Finally.

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[Temeraire]

I thought this day would never come.

 

[Direct Laryngoscopy]

Will probably be cost prohibitive for most institutions, but nonetheless good news.

 

[GaseousClay]

should we buy merck stock?

 

[pgg]

Excellent.

Can't wait to see what it costs!

 

[ZzzPlz]

should we buy merck stock?

Probably too late at this point

 

[vector2]

It'll probably be locked up so tight in most institutions that in an emergency situation you'll need to make 8 phone calls and fill out 15 TPS reports before pharmacy even gives it to you. After some quick googling, a 2ml (100mg/ml) vial of Bridion in 2013 was priced at $800 US in new zealand. Keep in mind, the dose to immediately reverse a 1.2mg/kg roc RSI is 16mg/kg of sugammadex (usual dose is 2-4mg/kg at the end of routine surgery when twitches have returned).

 

[drmwvr]

Don't get the enthusiasm. Interesting drug, surely, but it's an NMB reversal agent that is distinguished from what we already have in infrequent scenarios. Do people still keep patients so paralyzed?

Reminds me of the enthusiasm for rapacuronium.

 

[pgg]

Don't get the enthusiasm. Interesting drug, surely, but it's an NMB reversal agent that is distinguished from what we already have in infrequent scenarios. Do people still keep patients so paralyzed?

Neostigmine and succinylcholine are dirty drugs.

When the day comes that sugammadex is cheap, I'll never use neostigmine again. And my already rare use of succ will become exceedingly rare.

That's all.

 

[pjl]

Based on some information I looked at, it decreases the efficacy of birth control, as an interesting side effect.

 

[gasp]

Don't get the enthusiasm. Interesting drug, surely, but it's an NMB reversal agent that is distinguished from what we already have in infrequent scenarios. Do people still keep patients so paralyzed?

Reminds me of the enthusiasm for rapacuronium.

Of course man. Some surgeons want full relaxation 0/4 TOF during closing..

 

[Mman]

Of course man. Some surgeons want full relaxation 0/4 TOF during closing..

that doesn't mean you accommodate that request. little white lie never hurt anybody (pun intended since you can just push propofol and tell them they are 0/4)

 

[Fajardo04]

This drug has been standard of care all over the world for years. It will absolutely save lives and prevent many reintubations in the PACU. If you haven't run into residual paralysis after giving rocuronium, then you need to spend some time doing real cases and get out of the surgery center. Glad the FDA finally pulled its head out of its ass. I just hope it's priced reasonably.

 

[drmwvr]

This drug has been standard of care all over the world for years. It will absolutely save lives and prevent many reintubations in the PACU. If you haven't run into residual paralysis after giving rocuronium, then you need to spend some time doing real cases and get out of the surgery center. Glad the FDA finally pulled its head out of its ass. I just hope it's priced reasonably.

Residual paralysis after using rocuronium isn't a function of where cases are done. It's a function of a premature or inappropriate reversal. Glad there's medicine for that.

 

[dannyboy1]

This drug has been standard of care all over the world for years. It will absolutely save lives and prevent many reintubations in the PACU. If you haven't run into residual paralysis after giving rocuronium, then you need to spend some time doing real cases and get out of the surgery center. Glad the FDA finally pulled its head out of its ass. I just hope it's priced reasonably.

??. How much roc are you using.? I have never run into residual paralysis needing reintubation (frequently i dont even reverse). not sure how many lives this will save as we have been using nondepolarizers until now with a great safety record. (im sure that the glidescope has saved countless more lives than sugammadex ever will)

 

[WholeLottaGame7]

??. How much roc are you using.? I have never run into residual paralysis needing reintubation (frequently i dont even reverse). not sure how many lives this will save as we have been using nondepolarizers until now with a great safety record. (im sure that the glidescope has saved countless more lives than sugammadex ever will)

He didn't say residual paralysis needing reintubation, he said residual paralysis. There are any number of studies showing an increase in postoperative complications with TOF <0.9. His point is that it doesn't usually matter for ASC patients (ASA 1 or 2) because they are otherwise healthy and can handle minor derangements. It matters for the ASA 3 and 4 patients who can't handle a little hypercarbia or aspiration or what-have-you.

 

[Mman]

??. How much roc are you using.? I have never run into residual paralysis needing reintubation (frequently i dont even reverse). not sure how many lives this will save as we have been using nondepolarizers until now with a great safety record. (im sure that the glidescope has saved countless more lives than sugammadex ever will)

Residual paralysis is pretty common if you actually bother measuring it, at least it is in places that don't use quantitative TOF measurements. Do those people need to be reintubated all the time? Of course not. Sometimes it's just microaspiration and hypoventilation. But in big enough populations those things cause problems.

 

[lobelsteve]

Based on some information I looked at, it decreases the efficacy of birth control, as an interesting side effect.

Based on some information I looked at, it decreases the efficacy of birth control, as an interesting side effect.

Just do your job and stop peaking over the curtain. Iys,not like if you give this drug I'd have time to put on a condom.

 

[dhb]

Been available for some years now, never used it...

 

[pgg]

Been available for some years now, never used it...

What does it cost you?

 

[caligas]

For the record, neo/glyco are not that cheap. Reintubation is also expensive.

 

[dhb]

What does it cost you?

Paperwork : the patient is covered by social security if you use it within the accepted scenarios but i never felt the urge to use it.
I don't feel as strongly as you about neostigmine: in small doses it's not that bad

 

[dhb]

For the record, neo/glyco are not that cheap. Reintubation is also expensive.

I've never reintubated a patient...

 

[Mman]

I've never reintubated a patient...

not extubating enough people?

 

[Fajardo04]

I've never reintubated a patient...

CRNA does it for you?

 

[deleted162650]

I've never reintubated a patient...

He just let's 'em croak.

 

[dhb]

Ok since i'm getting roasted i'll say that i meant that i never reintubated a patient in the pacu. I have in the OR: one case of laryngospasm in a kid comes to mind but this is exceedingly rare.
Don' know why you would need to reintubate patients regularly? different population maybe? morbid obesity is not too prevalent here.

 

[Mman]

Don' know why you would need to reintubate patients regularly? different population maybe? morbid obesity is not too prevalent here.

I don't think anybody "regularly" needs to reintubate people in the PACU. But over the course of thousands of anesthetics, it happens.