A reply

Abstract

In response to Dr Harris’s letter, we wanted to highlight that a newly introduced drug, such as sugammadex in our department, might cause some confusion when the anaesthetist is not aware of its previous administration. Surprisingly, despite the absence of adequate neuromuscular blockade, the conditions during tracheal intubation were excellent. Following induction of anaesthesia with propofol, fentanyl and rocuronium, no reaction to placement of the tracheal tube was observed although relaxometry revealed a lasting 100% train-of-four ratio. Atracurium and cisatracurium are not the drugs of choice in emergency operations when rapid sequence induction is required in a patient with acute renal failure and urosepsis. Administration of atracurium, even when using the priming principle, has prolonged mean onset times, making this drug less ideal in avoiding aspiration of stomach contents in emergency surgical operations [1]. We therefore preferred rocuronium due to its short onset time and low rate of side-effects, having taken into account that the action of rocuronium is markedly prolonged in elderly patients with renal failure [2]. Sugammadex has effectively reversed moderate rocuronium-induced neuromuscular blockade in patients with renal failure [3]. If re-intubation is required after reversal of neuromuscular blockade with sugammadex, re-onset of block following rocuronium administration may be delayed but can be successfully re-introduced within 5 min after sugammadex administration [4]. We wanted to emphasise in our letter that reversal of neuromuscular block with sugammadex might cause prolonged impairment of the action of steroidal neuromuscular blocking drugs in concurrent surgical procedures, especially in the presence of renal insufficiency. Administration of sugammadex needs to be well documented and information should be transferred personally from one anaesthetic team to the next to prevent unexpected failure of neuromuscular blockade. Furthermore, in the absence of renal function, the fate of the rocuronium-sugammadex complex is still unclear and needs to be clarified in further studies. No external funding and no competing interests declared. Previously posted at the Anaesthesia Correspondence website: http://www.anaesthesiacorrespondence.com.