Anaesthesia Learning Hub

Anaesthesia Learning Hub

Prescribing Information (Great Britain) & Prescribing Information (Northern Ireland) [External links]

BRIDION is for the reversal of neuromuscular blockade induced by rocuronium or vecuronium in adults1

For the paediatric population, sugammadex is only recommended for routine reversal of rocuronium induced blockade in children and adolescents aged 2 to 17 years1

Anaesthesia Podcast Series

Episode 1: Judicious Neuromuscular Blockade Management (NMB) is Paramount for Patient Care

Gain a deeper understanding of the fundamental issues in Neuromuscular Blockade Management, in order to improve patient care

Prescribing Information (Great Britain) & Prescribing Information (Northern Ireland) [External links]

Length: 17:39 minutes

Host: Dr Friedrich Pühringer
Department of Anaesthesiology and Intensive Care Medicine, University of Tübingen, Germany

Guest: Dr Glenn Murray
Department of Anaesthesiology, NorthShore University Health System, USA

References

  1. Anesthesia: Techniques and Agents. Ch 24. In: Phillips N, Hornacky A, eds. Berry & Kohn’s Operating Room Technique. 14th ed. Elsevier, Inc.; 2021:421-454.
  2. Brull SJ, Kopman AF, Naguib M. Management principles to reduce the risk of residual neuromuscular blockade. Curr Anesthesiol Rep. 2013;3:130-138. doi: 10.1007/s40140-013-0014-9.
  3. Lundstrøm LH, Duez CH, Nørskov AK, et al. Effects of avoidance or use of neuromuscular blocking agents on outcomes in tracheal intubation: a Cochrane systematic review. Br J Anaesth. 2018;120(6):1381-93. doi: 10.1016/j.bja.2017.11.106.
  4. Bruintjes MH, van Helden EV, Braat AE, et al. Deep neuromuscular block to optimize surgical space conditions during laparoscopic surgery: a systematic review and meta-analysis. Br J Anaesth. 2017;118(6):834-842. doi:10.1093/bja/aex116.
  5. Plaud B, Baillard C, Bourgain J-L, et al. Guidelines on muscle relaxants and reversal in anaesthesia. Updated guidelines from the French Society of Anaesthesia & Intensive Care Medicine. Anaesth Crit Care Pain Med. 2020:39(1):125-142. doi: 10.1016/j.accpm.2020.01.005.
  6. Özdemir-van Brunschot DMD, van Laarhoven KCJHM, Scheffer G-J, Pouwels S, Wever KE, Warlé MC. What is the evidence for the use of low-pressure pneumoperitoneum? A systematic review. Surg Endosc. 2016;30:2049-2065. doi: 10.1007/s00464-015-4454-9.
  7. Naguib M, Brull SJ, Johnson KB. Conceptual and technical insights into the basis of neuromuscular monitoring. Anaesthesia. 2017;72(suppl 1):16-37. doi:10.1111/anae.13738.
  8. Claudius C, Fuchs-Buder T. Neuromuscular monitoring. In: Gropper MA, Cohen NH, Eriksson LI, et al, eds. Miller’s Anesthesia. 9th ed. Philadelphia, PA: Elsevier; 2020:1354-1372.
  9. Fuchs-Buder T, Nemes R, Schmartz D. Residual neuromuscular blockade. management and impact on postoperative pulmonary outcome. Curr Opin Anesthesiol. 2016;29:662-667. doi: 10.1097/ACO.0000000000000395.
  10. Klein AA, Meek T, Allcock E, et al. Recommendations for standards of monitoring during anaesthesia and recovery 2021. Guideline from the Association of Anaesthetists. Anaesthesia. 2021;76:1212-1223. doi: 10.1111/anae.15501.
  11. Checketts MR, Alladi R, Ferguson K, et al. Recommendations for standards of monitoring during anaesthesia and recovery 2015: Association of Anaesthetists of Great Britain and Ireland. Anaesthesia. 2016;71(1):85-93. doi:10.1111/anae.13316.
  12. Debaene B, Plaud B, Dilly M-P, Donati F. Residual paralysis in the PACU after a single intubating dose of nondepolarizing muscle relaxant with an intermediate duration of action. Anesthesiology. 2003;98(5):1042-1048. doi: 10.1097/00000542-200305000-00004.
  13. Fuchs-Buder T, de Robertis E, Brunaud L. Neuromuscular block in laparoscopic surgery. Minerva Anestesiol. 2018;84(4):509-514. doi: 10.23736/S0375-9393.17.12330-8.
  14. Murphy G, de Boer H, Eriksson LI, Miller RD. Reversal (antagonism) of neuromuscular blockade. In: Gropper MA, Cohen NH, Eriksson LI, et al, eds. Miller’s Anesthesia. 9th ed. Elsevier; 2020:832-864.
  15. Brull SJ, Kopman AF. Current status of neuromuscular reversal and monitoring. Challenges and opportunities. Anesthesiology. 2017;126:173-190. doi: 10.1097/ALN.0000000000001409.
  16. Capron F, Alla F, Hottier C, et al. Can acceleromyography detect low levels of residual paralysis? Anesthesiol. 2004;100(5):1119-1124. doi: 10.1097/00000542-200405000-00013.
  17. Saager L, Maiese EM, Bash LD, et al. Incidence, risk factors, and consequences of residual neuromuscular block in the United States: the prospective, observational, multicenterRECITE-US study. J Clin Anesthesia. 2019;55:33-41. doi: 10.1016/j.jclinane.2018.12.042.
  18. Yu B, Ouyang B, Ge S, et al. Incidence of postoperative residual neuromuscular blockade after general anesthesia: a prospective, multicenter, anesthetist-blind, observational study. CurrMed Res Opin. 2016;32(1):1-9. doi:10.1185/03007995.2015.1103213.
  19. Plaud B, Debaene B, Donati F, Marty J. Residual paralysis after emergence from anesthesia. Anesthesiology. 2010;112:1013-1022. doi: 10.1097/ALN.0b013e3181cded07.

Episode 2: Surgical Patients at Risk of Postoperative Pulmonary Complications

Listen to experienced specialists discuss the issues and challenges facing surgical patients at risk for Postoperative Pulmonary Complications

Prescribing Information (Great Britain) & Prescribing Information (Northern Ireland) [External links]

Length: 18:56 minutes

Host: Dr Friedrich Pühringer
Department of Anaesthesiology and Intensive Care Medicine, University of Tübingen, Germany

Guest: Dr Sorin Brull
Department of Anaesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, USA

References

  1. Miskovic A, Lumb AB. Postoperative pulmonary complications. Br J Anaesth. 2017;118(3):317-334.
  2. Abbott TEF, Fowler AJ, Pelosi P, et al. A systematic review and consensus definitions for standardised endpoints in perioperative medicine: pulmonary complications. Br J Anaesth. 2018;120(5):1066-1079.
  3. Jammer I, Wickboldt N, Sander M, et al. Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions: a statement from the ESA-ESICM joint taskforce on perioperative outcome measures. Eur J Anaesthesiol. 2015;32:88-105.
  4. Jin Y, Xie G, Wang H, et al. Incidence and risk factors of postoperative pulmonary complications in noncardiac Chinese patients: a multicenter observational study in university hospitals. Biomed Res Int. 2015. doi. org/10.1155/2015/265165.
  5. Herbstreit F, Peters J, Eikermann M. Impaired upper airway integrity by residual neuromuscular blockade. Anesthesiol. 2009;110:1253-1260.
  6. Tevis S, Kennedy G. Postoperative complications and implications on patient-centered outcomes. J Surg Res. 2013;181(1):106-113.
  7. Gallart L, Canet J. Post-operative pulmonary complications: understanding definitions and risk assessment. Best Pract Res Clin Anaesth. 2015;29:315-330.
  8. Patel K, Hadian F, Ali A, et al. Postoperative pulmonary complications following major elective abdominal surgery: a cohort study. Perioper Med. (Lond). 2016;5:10.
  9. Davies OJ, Husain T, Stephens RCM. Postoperative pulmonary complications following non- cardiothoracic surgery. BJA Education. 2017;17(9):295-300.
  10. Canet J, Gallart L, Gomar C, et al. Prediction of postoperative pulmonary complications in a population- based surgical cohort. Anesthesiology. 2010;113:1338-1350.
  11. Pöpping DM, Elia N, Van Aken HK, et al. Impact of epidural analgesia on mortality and morbidity after surgery. Systematic review and meta-analysis of randomized controlled trials. Ann Surg. 2014;259:1056- 1067.
  12. Wilson J, Collins AS, Rowan BO. Residual neuromuscular blockade in critical care. Crit Care Nurse. 2012;32(3):e1-e9.
  13. Ferrando C, Soro M, Unzueta C, et al. Individualised perioperative open-lung approach versus standard protective ventilation in abdominal surgery (iPROVE): a randomised controlled trial. Lancet Respir Med. 2018;6:193-203.
  14. Garutti I, Errando CL, Mazzinari G ,et al. Spontaneous recovery of neuromuscular blockade is an independent risk factor for postoperative pulmonary complications after abdominal surgery: a secondary analysis. Eur J Anaesthesiol. 2020;37(3):203-211.
  15. Stones J, Yates D. Clinical risk assessment tools in anaesthesia. Br J Anaesth Education. 2019;19(2):47- 53.
  16. Chandler D, Mosieri C, Kallurkar A, et al. Perioperative strategies for the reduction of postoperative pulmonary complications. Best Pract Res Clin Anaesth. 2020;34(2):153-166.
  17. Sabate S, Mazo V, Canet J. Predicting post operative pulmonary complications: implications for outcomes and costs. Curr Opin Anesthesiol. 2014;27:201-209.
  18. Gupta S, Fernandes RJ, Rao JS, et al. Perioperative risk factors for pulmonary complications after non- cardiac surgery. J Anaesthesiol Clin Pharmacol. 2020;36:88-93.
  19. Rudolph MI, Ng PY, Hao D, et al. Comparison of a novel clinical score to estimate the risk of Residual neuromuscular block Prediction Score and the last train-of-four count documented in the electronic anaesthesia record. Eur J Anaesthesiol. 2018;35:883-892.
  20. Patrocinio MD, Shay D, Rudolph MI, et al. Residual Neuromuscular Block Prediction Score versus train- of-four ratio and respiratory outcomes: a retrospective cohort study. Anes Analg. 2021;133(3):610-619.

References

  1. BRIDION (sugammadex) Summary of Product Characteristics.

Supporting documentation

BRIDION (sugammadex)
Prescribing Information (Great Britain) & Prescribing Information (Northern Ireland)

By clicking the links above you will leave the MSD Connect website and be taken to the emc PI portal website

GB-XBR-00460 | Date of preparation: March 2023