Palmo Anest

Sugammadex

In May 2005, Chen, Gasman and I have a short discussion about use of esmeron and suxamethonium in the post I blogged about the new reversal agent of Esmeron (a neuromascular bloking agant): the Org 25969, which is now called Sugammadex.

If this Org 25969 gets to the market, we can all dump Sux away and use Esmeron for all the emergency airway right? Wonder how is the cost like?

At 5/23/2005 3:21 PM, Gasman said...

well, actually Esmeron is not so expensive if you consider all those nightmare of MH like the one you had in your hospital. At least, you have peace of mind...
From my personal experince, Esmeron is not the so called 90sec intubation drug if you don't use volatile agent and 50% to 50% of Oxygen and N2O
How about you?

At 5/23/2005 3:57 PM, LT said...

I usually intubate <60sec after Esmeron too.

My concern is in cases of dificult airway, if it's really really bad one, do u still use Esmeron? I'll go for short acting in that case.

So with this new drug from Organon, we can safely use Esmeron. If really can't intubate & can't ventilate, just reverse it STAT. Simple & easy.

Interested to know the cost of this Org 25969.

At 5/23/2005 8:31 PM, Gasman said...

Pretty interesting, wish to know the drug better...

At 5/26/2005 12:23 PM, Chen said...

I will still use Suxamethonium in suspected difficult airway & in all maternity cases which require GA. Rocuronium still cannot replace Suxamethonium...

Just my 2 cents

At 5/26/2005 6:31 PM, LT said...

Point noted. :)

I still use sux for my LSCS majority of my emergency cases.

However I think with this combo of
Esmeron and Org 25969, we'd b safer in situation where sux is contraindicated. It's a safer alternative.

What is this Sugammadex? According to Organon, the pharmaceutical which produce Sugammadex,

Sugammadex (Org 25969) is a cyclodextrin derivative that has been designed to specifically encapsulate the steroidal NMBA’s Esmeron/Zemuron and Norcuron. Once these steroidal agents have entered the sugammadex molecule, their actions are prevented and almost instant recovery of neuromuscular function occurs.

Sugammadex is the first “selective relaxant binding agent” (SRBA), a new class of agents to reverse neuromuscular block, providing unprecedented control of neuromuscular block. Sugammadex allows the anesthesiologist to maintain deep neuromuscular block throughout the entire surgical procedure, thus providing the optimal surgical conditions until rapid recovery is required.

I was excited to see that one day we can all forget about Suxamethonium and confidently use this combination of Esmeron and Sugammadex even with suspected difficult intubation case. Especially after I seen and involved in management of a case of Malignant Hyperthermia after the use of Suxamethonium.

Seems like I'm not alone in this 'prediction' and looking forward to the 'taking over' of Esmeron from Suxamethonium.

'The Man' in anaesthesiology, Prof. Ronald D Miller also talk about this and think the same in the 14th ASEAN Congress of Anaesthesiologist in Hanoi, Vietnam recently. There is a similar symposium talk he co-chaired in ESA2005, Vienna, in PDA format for viewing.

The recent development of sugammadex (Org 25969), the first of a new
class of selective relaxant binding agents (SRBAs), now offers a new concept of how safe, rapid reversal of neuromuscular block might be achieved.

Sugammadex has the potential to revolutionize neuromuscular recovery by offering fast, effective, and complete reversal of a rocuronium or vecuronium block irrespective of the degree of neuromuscular block.

Sugammadex can allow excellent relaxation to be maintained until the end of surgery, followed by a rapid reversal of block. Sugammadex is effective at both superficial and profound blocks, has no observable muscarinic/vagolytic or other significant side
effects, and may prevent postoperative residual curarization.

I'm sure there are still a lot of Anaesthtist don't agree with me and think that we still needs Suxamethonium. I just hope that they are wrong. :)

Will share with u guys who are interested in this new agent the latest published study which just published in BJA (British Journal of Anaesthesia) this Nov.

Cheers. Happy gassing and safe relaxing.. :)

posted by LT @ 11:31 PM