Öz
Kaynakça
- Naguib M, Kopman AF, Lien CA, Hunter JM, Lopez A, Brull SJ. A survey of current management of neuromuscular block in the United States and Europe. Anesth Analg 2010; 111: 110-9.
- Kim KS, Lew SH, Cho HY, Cheong MA. Residual paralysis induced by either vecuronium or rocuronium after reversal with pyridostigmine. Anesth Analg 2002; 95: 1656-60.
- Sacan O, White PF, Tufanogulları B, Klein K. Sugammadex reversal of rocuronium-induced neuromuscular blockade: a comparison with neostigmineglycopyrrolate and edrophonium-atropine. Anesth Analg 2007; 104: 569-74.
- Flockton EA, Mastronardi P, Hunter JM, Gomar C, Mirakhur RK, Aguilera L, Giunta FG, Meistelman C, Prins Me. Reversal of rocuronium-induced neuromuscular block with sugammadex is faster than reversal of cisatracuriuminduced block with neostigmine. Br J Anaesth 2008; 100: 622-30.
- Blobner M, Eriksson LI, Scholz J, Motsch J, Della Rocca G, Prins ME. Reversal of rocuronium-induced neuromuscular blockade with sugammadex compared with neostigmine during sevoflurane anaesthesia: results of a randomised, controlled trial. Eur j Anaesthesiol 2010; 27: 874-81.
- Claudius C, Garvey LH, Viby-Mogensen J. The undesirable effects of neuromuscular blocking drugs. Anaesthesia 2009; 64 Suppl 1: 10-21.
- Murphy GS, Szokol JW, Marymont JH, Greenberg SB, Avram MJ, Vender JS. Residual neuromuscular blockade and critical respiratory events in the postanesthesia care unit. Anesth Analg 2008; 107: 130-7.
- Illman Hl, Laurila P, Antila H, Meretoja OA, Alahuhta S, Olkkola KT. The duration of residual neuromuscular block after administration of neostigmine or sugammadex at two visible twitches during train-of-four monitoring. Anesth Analg 2011; 112: 63-8.
- Paton F, Paulden M, Chambers D, Heirs M, Duffy S, Hunter JM, Sculpher M, Woolacott N. Sugammadex compared with neostigmine/glycopyrrolate for routine reversal of neuromuscular block: a systematic review and economic evaluation. Br J Anaesth 2010; 105: 558-67.
- De Boer HD. Neuromuscular transmission: new concepts and agents. J Crit Care 2009; 24: 36-42.
- Lenz A, Hill G, White PF. Emergency use of sugammadex after failure of standard reversal drugs. Anesth Analg 2007; 104: 585-6.
- Della Rocca G, Pompei L. A novel approach to reversal of neuromuscular blockade. Minerva Anestesiol 2009; 75: 349-51.
- Brull SJ, Naguib M. Selective reversal of muscle relaxation in general anesthesia: focus on sugammadex. Drug Des Devel Ther 2009; 3: 119-29.
- Naguib M, Kopman AF, Ensor JE. Neuromuscular monitoring and postoperative residual curarisation: a meta-analysis. Br J Anaesth 2007; 98: 302-16.
Öz
Özet
Nondepolarizan kas gevşetici ajanların etkilerinin uzamasına bağlı olarak gelişen postoperatif rezidüel kürarizasyon modern anestezide hala yaygın görülen ve hasta güvenliğine ciddi tehdit oluşturan önemli bir problemdir. Anestezi sonrasında rezidüel nöromusküler blok, uygun şekilde döndürülmezse postoperatif pulmoner komplikasyonların gelişimini ve postoperatif mortaliteyi arttırır. Spinal kitle nedeniyle opere edilen Amerikan Anestezistler Derneği II risk grubu olgumuzda nöromusküler bloker olarak roküronyum kullanıldı. Operasyonun sonunda roküronyuma bağlı rezidüel nöromusküler bloğu döndürmek için neostigmin kullanılmasına rağmen hastada solunum yetmezliği gelişti. Kas gücü yetersiz olan hasta ajite, taşikardik, takipneik ve tidal volümü düşüktü. Postoperatif rezidüel kürarizasyonu döndürmede neostigminin başarısız olması üzerine, hastaya modifiye γ- siklodekstrin yapısındaki 200 mg sugammadeks uygulandı. Nöromusküler bloğun hızlı ve etkili bir şekilde döndüğü tespit edildi. Sonuç olarak geleneksel antikolinerjik ajanların başarısız olduğu roküronyuma bağlı rezidüel kürarizasyonda sugammadeks kullanımının güvenilir ve etkin olduğunu düşünüyoruz.
Anahtar sözcükler: Sugammadeks, Neostigmin, Rezidüel kürarizasyon
Abstract
Postoperative residual curarization caused by prolonged effect of non-depolarizing neuromuscular blocking agents is still a serious, frequent and life threatening problem in modern anesthesia. If postoperative residual neuromuscular block cannot be recovered properly, postoperative pulmonary complications and mortality may increase. We used rocuronium as a neuromuscular blocker in our American Society of Anesthesiologists II risked patient which was operated for a spinal mass. Respiratory failure was occurred in our patient despite the usage of neostigmine for recovering neuromuscular block caused by rocuronium. The patient was tachycardic, tachypneic, the tidal volume was decreased and the muscle strength was weak. After the ineffectiveness of neostigmine in recovering neuromuscular blockage, 200mg sugammadex which is a modified γ-cyclodextrin was given to the patient. We observed that neuromuscular blockage was recovered rapidly and effectively. In conclusion, we think that using sugammedex is effective and safe in residual curarization caused by rocuronium in which traditional anticholinergic agents are not successful.
Keywords: Sugammadex, neostigmine, residual curarization
Anahtar Kelimeler
Kaynakça
- Naguib M, Kopman AF, Lien CA, Hunter JM, Lopez A, Brull SJ. A survey of current management of neuromuscular block in the United States and Europe. Anesth Analg 2010; 111: 110-9.
- Kim KS, Lew SH, Cho HY, Cheong MA. Residual paralysis induced by either vecuronium or rocuronium after reversal with pyridostigmine. Anesth Analg 2002; 95: 1656-60.
- Sacan O, White PF, Tufanogulları B, Klein K. Sugammadex reversal of rocuronium-induced neuromuscular blockade: a comparison with neostigmineglycopyrrolate and edrophonium-atropine. Anesth Analg 2007; 104: 569-74.
- Flockton EA, Mastronardi P, Hunter JM, Gomar C, Mirakhur RK, Aguilera L, Giunta FG, Meistelman C, Prins Me. Reversal of rocuronium-induced neuromuscular block with sugammadex is faster than reversal of cisatracuriuminduced block with neostigmine. Br J Anaesth 2008; 100: 622-30.
- Blobner M, Eriksson LI, Scholz J, Motsch J, Della Rocca G, Prins ME. Reversal of rocuronium-induced neuromuscular blockade with sugammadex compared with neostigmine during sevoflurane anaesthesia: results of a randomised, controlled trial. Eur j Anaesthesiol 2010; 27: 874-81.
- Claudius C, Garvey LH, Viby-Mogensen J. The undesirable effects of neuromuscular blocking drugs. Anaesthesia 2009; 64 Suppl 1: 10-21.
- Murphy GS, Szokol JW, Marymont JH, Greenberg SB, Avram MJ, Vender JS. Residual neuromuscular blockade and critical respiratory events in the postanesthesia care unit. Anesth Analg 2008; 107: 130-7.
- Illman Hl, Laurila P, Antila H, Meretoja OA, Alahuhta S, Olkkola KT. The duration of residual neuromuscular block after administration of neostigmine or sugammadex at two visible twitches during train-of-four monitoring. Anesth Analg 2011; 112: 63-8.
- Paton F, Paulden M, Chambers D, Heirs M, Duffy S, Hunter JM, Sculpher M, Woolacott N. Sugammadex compared with neostigmine/glycopyrrolate for routine reversal of neuromuscular block: a systematic review and economic evaluation. Br J Anaesth 2010; 105: 558-67.
- De Boer HD. Neuromuscular transmission: new concepts and agents. J Crit Care 2009; 24: 36-42.
- Lenz A, Hill G, White PF. Emergency use of sugammadex after failure of standard reversal drugs. Anesth Analg 2007; 104: 585-6.
- Della Rocca G, Pompei L. A novel approach to reversal of neuromuscular blockade. Minerva Anestesiol 2009; 75: 349-51.
- Brull SJ, Naguib M. Selective reversal of muscle relaxation in general anesthesia: focus on sugammadex. Drug Des Devel Ther 2009; 3: 119-29.
- Naguib M, Kopman AF, Ensor JE. Neuromuscular monitoring and postoperative residual curarisation: a meta-analysis. Br J Anaesth 2007; 98: 302-16.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Olgu Sunumları |
| Yazarlar | |
| Yayımlanma Tarihi | 21 Haziran 2012 |
| Yayımlandığı Sayı | Yıl 2012Cilt: 34 Sayı: 2 |