Sugammadex for rocuronium rapid sequence induction

Abstract

We read with interest and some concern the study investigating the simulated use of sugammadex in the ‘can’t intubate, can’t ventilate’ situation [1]. We agree that the use of sugammadex is not common and that anaesthetists are not immediately familiar with the doses. Moreover, we cannot see this changing in the current financial climate. We also agree that calculating and administering the correct dose is essential, but we believe that the authors’ suggestion of storing sugammadex in all anaesthetic trolleys is not likely to happen in our hospital. We have a stock in a central store, which is at most fifty yards from each of the twelve theatres in our theatre suite. We cannot envisage that our hospital would purchase sufficient drug to have sugammadex available in appropriate quantities for high-dose reversal in all of these theatres. We have already noted that this small store can be wasted as vials become out of date due to infrequent use. When undertaking rapid sequence induction with rocuronium, our practice is to calculate the appropriate dose of sugammadex before induction of anaesthesia, and to have this ready in the anaesthetic room with a labelled syringe to hand. We do not draw up the drug unless it is required. This reduces time that may be wasted trying to find and decide on the correct dose of the drug. We feel this addresses the problem without wasting large amounts of an expensive drug. It also allows us to become increasingly familiar with calculating the dose of suggamadex for use in an emergency ‘can’t intubate, can’t ventilate’ situation in case the real scenario arises. No external funding and no competing interests declared. Previously posted at the Anaesthesia Correspondence website: http://www.anaesthesiacorrespondence.com.