Use of sugammadex in patients with neuromuscular disorders: a systematic review of case reports

Usha Gurunathan,Lisa May Lin Stanton,Shakeel Meeran Kunju

doi:10.1186/s12871-019-0887-3

Usha Gurunathan, Lisa May Lin Stanton + Show 1 more

Open Access

https://doi.org/10.1186/s12871-019-0887-3

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Abstract

BackgroundSugammadex is a modified gamma-cyclodextrin that acts by selectively encapsulating free amino-steroidal neuromuscular relaxants. Several case reports have been published on the use of sugammadex in patients with neuromuscular disorders that include neuromuscular junction diseases, myopathies, neuropathies, and motor neurone disorders. The primary aim of this review is to systematically review the evidence on the use of sugammadex in patients with this heterogeneous group of diseases and provide recommendations for clinical practice.MethodsA systematic electronic search of Medline, Embase and CINAHL databases was done until June 2019, to identify case reports describing the use of sugammadex in adult surgical patients with neuromuscular disorders.ResultsOf the 578 records identified through database searches, 43 articles were finally included for the systematic review. Of these, 17 reports were on patients with myopathy, 15 reports on myasthenia gravis, 9 reports on motor neuron diseases and 2 reports on neuropathies.ConclusionsMajority of the articles reviewed report successful use of sugammadex to reverse steroidal muscle relaxants, especially rocuronium, in patients with neuromuscular diseases. However, with sugammadex, unpredictability in response and uncertainty regarding optimum dose still remain issues. Quantitative neuromuscular monitoring to ensure complete reversal and adequate postoperative monitoring is strongly recommended in these patients, despite the use of sugammadex.

Highlights

Sugammadex is a modified gamma-cyclodextrin that acts by selectively encapsulating free aminosteroidal neuromuscular relaxants
They can be classified into motor neuron diseases, neuropathies, neuromuscular junction disorders or myopathies depending on which section of neuromuscular system is affected [1] (Table 1)
Sugammadex (Bridion®, Organon/Schering-Plough USA) a modified γ- cyclodextrin, acts by selectively encapsulating free molecules of amino steroidal neuromuscular relaxants such as vecuronium and rocuronium forming 1:1 inclusion complex in the plasma, thereby creating a concentration gradient resulting in the reduction of the relaxant available at the neuromuscular junction [5,6,7]

Summary

Introduction

Sugammadex is a modified gamma-cyclodextrin that acts by selectively encapsulating free aminosteroidal neuromuscular relaxants. Neuromuscular disorders are a large heterogeneous group of diseases that are usually progressive and produce symptoms at widely differing age ranges with varying degrees of severity [1]. They can be classified into motor neuron diseases, neuropathies, neuromuscular junction disorders or myopathies depending on which section of neuromuscular system is affected [1] (Table 1). There have been several publications expressing concerns over the choice of muscle relaxants in patients with neuromuscular disorders presenting for Sugammadex (Bridion®, Organon/Schering-Plough USA) a modified γ- cyclodextrin, acts by selectively encapsulating free molecules of amino steroidal neuromuscular relaxants such as vecuronium and rocuronium forming 1:1 inclusion complex in the plasma, thereby creating a concentration gradient resulting in the reduction of the relaxant available at the neuromuscular junction [5,6,7]. Sugammadex has been found to have a good safety profile so far, compared with neostigmine [9]

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