If using sugammadex, do you check twitches?

[AdmiralChz]

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I always check TOF/tetany quickly with a simple monitor. I agree with PGG the other stuff is superfluous, and virtually 100% of my patients have arms tightly tucked anyway.

Just yesterday I reversed with 200 of sugammadex ~ 15 min after a roc bolus, found only 2/4 TOF. Fully reversed with tetany after another 200. It’s also a MIPS measurement (or at least was recently). It’s one of like 2-3 times I’ve had to give more than 200, but I’m so used to checking twitches after reversal anyway… I I feel like it only helps support strong documentation.

 

[CopaceticOne]

I always check TOF/tetany quickly with a simple monitor. I agree with PGG the other stuff is superfluous, and virtually 100% of my patients have arms tightly tucked anyway.

Just yesterday I reversed with 200 of sugammadex ~ 15 min after a roc bolus, found only 2/4 TOF. Fully reversed with tetany after another 200. It’s also a MIPS measurement (or at least was recently). It’s one of like 2-3 times I’ve had to give more than 200, but I’m so used to checking twitches after reversal anyway… I I feel like it only helps support strong documentation.

It’s only a MIPS measurement if you choose it to be.

I love how pharmacy complains about the cumulative cost of reversal drugs but there is no push back that the surgeons always need absolute and complete NMB at all times.

What I’ve noticed is that since sugammadex became more available residents & CRNAs are far less responsible in their roc dosing. No more shame in having to wait for twitches to come back before being able to give reversal.

Heck, I would just get blank stares when I would tell a resident they didn’t need to give any additional paralytic for a lower extremity ortho case (with an inflated tourniquet!) when the curare clefts started showing up.

 

[abolt18]

"The sugammadex-rocuronium inclusion complex has a very high association constant (1.79 x 10 mol/L).[5] Higher association constants mean the affinity between molecules is greater. Using this association constant, it has been calculated that the ratio of sugammadex-rocuronium inclusion complexes to sugammadex-rocuronium dissociations is 25 million to 1.[6] Thus, once rocuronium is bound to sugammadex, it can be considered irreversibly fixed."

Sugammadex - StatPearls - NCBI Bookshelf

www.ncbi.nlm.nih.gov

Even if the roc-sugammadex complex DOES break down, it's going to be at such a slow rate as to be negligible, releasing individual rocuronium molecules into the system at such a slow rate they'd have virtually no effect.

 

[abolt18]

Anybody here using generic sugammadex yet?

 

[UscGhost]

"The sugammadex-rocuronium inclusion complex has a very high association constant (1.79 x 10 mol/L).[5] Higher association constants mean the affinity between molecules is greater. Using this association constant, it has been calculated that the ratio of sugammadex-rocuronium inclusion complexes to sugammadex-rocuronium dissociations is 25 million to 1.[6] Thus, once rocuronium is bound to sugammadex, it can be considered irreversibly fixed."

Sugammadex - StatPearls - NCBI Bookshelf

www.ncbi.nlm.nih.gov

Even if the roc-sugammadex complex DOES break down, it's going to be at such a slow rate as to be negligible, releasing individual rocuronium molecules into the system at such a slow rate they'd have virtually no effect.

Yup.

Not to mention the fact that roc+sug is going to be FAR more predictable in a esrd patient than roc/neo/glyco.