Sugammadex / Org 25969

[rn29306]

Your thoughts on this "selective relaxant binding agent" and avoiding traditional reversals?

http://www.organon.com/innovations/areas/anesthesia/index.asp

Yeah, I know it is off the company website, but still...

I guess my only concern would be of what duration or metabolism does the "encapsulating" agent go through after surrounding or binding to the Zemuron or Norcuron? Could possibly the NMB be re-released at any point, with paralysis re-occuring?

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[Skrubz]

Your thoughts on this "selective relaxant binding agent" and avoiding traditional reversals?

http://www.organon.com/innovations/areas/anesthesia/index.asp

Yeah, I know it is off the company website, but still...

I guess my only concern would be of what duration or metabolism does the "encapsulating" agent go through after surrounding or binding to the Zemuron or Norcuron? Could possibly the NMB be re-released at any point, with paralysis re-occuring?

they're supposedly running a trial/study of some sort here at stanford. i'll ask around to see if anyone knows more about the pharmacodynamics/kinetics... but the attendings who've mentioned it seem to think it's a wonder-drug. one likened it to a vacuum cleaner. i didn't know that it's supposed to work for vec too though.

no more giving the RSI-dose of roc for an ex-lap, only to have the surgeons look up immediately after opening the belly and say "it's carcinomatosis... we're going to close."

 

[rn29306]

Duration of action on the intubation dose of Zem is a significant drawback, IMHO. Assuming it clears FDA trials, I guess that won't be a factor anymore.

From what it sounds like, you can keep the patient extremely blocked (less than one twitch) then reverse with no consequences. How sweet would that be? No more tachycardia / bradycardia and no one pooping on the way to PACU from traditional reversals.

Time to invest in Organon and the company that makes the Glidescope.

 

[sevoflurane]

It won't be a cheap reversal agent for sure...

 

[VolatileAgent]

yeah, i agree with sevo. i think cost is going to be a significant limiting factor in its widespread use.

but, from what i understand, the cyclodextrin molecule is pretty specific to the steroid moeity of the nmb. it has a high affinity for roc and a pretty damn good affinity for vec. so, i don't think you'll have to worry about "unbinding". and, i still don't think you necessarily need a 100% soak-up of all free-floating nmb to get what we now accept as a full reversal. likewise, there may ultimately be some synergy between "old" techniques as well (using neo to augment).

still, price will be an issue and this will likely prohibit it from being a "routine use" drug, like at the end of a regular case after the closing and regular wake-up-to-pacu trip. most anesthesiologists/anesthetists are pretty good at getting someone to that point safely and effeciently. i see it being used more as a rescue drug in the pacu, for unanticipatedly short cases, or for huge belly cases where full relaxation will facilitate closing when near the end of the case.

 

[Mman]

Your thoughts on this "selective relaxant binding agent" and avoiding traditional reversals?

http://www.organon.com/innovations/areas/anesthesia/index.asp

Yeah, I know it is off the company website, but still...

I guess my only concern would be of what duration or metabolism does the "encapsulating" agent go through after surrounding or binding to the Zemuron or Norcuron? Could possibly the NMB be re-released at any point, with paralysis re-occuring?

I got to use this the other day and must say I was pretty impressed. Kept an 80 year old dude less than 1 twitch for 2 hours with Roc. Gave him a single dose of Sugammadex and he was fully reversed in about 5 or 6 minutes with zero change in hemodynamics. My N of 1 was an impressive result.

 

[bogatyr]

I got to use this the other day and must say I was pretty impressed. Kept an 80 year old dude less than 1 twitch for 2 hours with Roc. Gave him a single dose of Sugammadex and he was fully reversed in about 5 or 6 minutes with zero change in hemodynamics. My N of 1 was an impressive result.

What is the proper pronunciation of this new wonder drug? Is it like "sugar" or like "sufentanil?"

 

[rn29306]

What is the proper pronunciation of this new wonder drug? Is it like "sugar" or like "sufentanil?"

Sug-amma-dex (as in hug)

 

[undecided05]

The cost of the drug is going to be a lot cheaper than keeping a patient in the OR for an extra 15-30 minutes cause the srugeon closes early or actually quickly and your waiting to get your twitches back...

It's also supposedly going to eliminate SCh as a drug...

The only question I have is this... what happens when you have that patient that you go and reverse... and then boom somehting happens and need more muscle relaxant; ie pt needs to be re-intubated for airway protection or dude in PACU starts bleeding out and needs to go back to OR stat... ??

 

[UTSouthwestern]

The cost of the drug is going to be a lot cheaper than keeping a patient in the OR for an extra 15-30 minutes cause the srugeon closes early or actually quickly and your waiting to get your twitches back...

It's also supposedly going to eliminate SCh as a drug...

The only question I have is this... what happens when you have that patient that you go and reverse... and then boom somehting happens and need more muscle relaxant; ie pt needs to be re-intubated for airway protection or dude in PACU starts bleeding out and needs to go back to OR stat... ??

Give sux.

 

[rn29306]

It's also supposedly going to eliminate SCh as a drug...

Sugammadex is just the reversal.

IMHO I don't think Zemuron will replace Anectine for true RSIs, given the onset differences for RSI dosages.

 

[jwk]

The cost of the drug is going to be a lot cheaper than keeping a patient in the OR for an extra 15-30 minutes cause the srugeon closes early or actually quickly and your waiting to get your twitches back...

It's also supposedly going to eliminate SCh as a drug...

The only question I have is this... what happens when you have that patient that you go and reverse... and then boom somehting happens and need more muscle relaxant; ie pt needs to be re-intubated for airway protection or dude in PACU starts bleeding out and needs to go back to OR stat... ??

What do you do now when that happens after you've already reversed?

 

[nimbus]

Not sure but I think sugammadex specifically binds the aminosteroidal NMBs and not the aminopyridines so something like nimbex should still work.