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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EUntil recently, the only ways to reverse the action of nondepolarizing muscle relaxant were with neostigmine or other anticholinesterase drugs. Now, a new option\u2014sugammadex\u2014has come on the market in Europe, Japan, and China. This article discusses the safety and efficacy of neostigmine.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ENeurological Autoimmune Diseases\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ENeuromuscular Blockade\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EAnalgesic Drugs\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EAnesthesiology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ENeurological Autoimmune Diseases\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ENeuromuscular Blockade\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EAnalgesic Drugs\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EUntil recently, the only ways to reverse the action of nondepolarizing muscle relaxant were with neostigmine or other anticholinesterase drugs. Now, a new option\u2014sugammadex\u2014has come on the market in Europe, Japan, and China. Glenn S. Murphy, MD, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA, spoke on the safety and efficacy of neostigmine. Thomas Fuchs\u2013Burder, MD, University of Lorraine, Nancy, Lorraine, France, reviewed the use of sugammadex in Europe.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003ENeostigmine has numerous side effects, such as bradycardia, nausea, and vomiting [Schaller SJ, Fink H. \u003Cem\u003ECore Evid.\u003C\/em\u003E 2013]. According to Dr Murphy, other side effects include an inability to reverse deep levels of blockade, a ceiling effect, slow onset, and paradoxical muscle weakness. It also frequently fails to fully reverse muscular blockade.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EIn a prospective cohort study on residual paralysis, 134 of 150 patients who were given neuromuscular blocking drugs received neostigmine [Thilen SR et al. \u003Cem\u003EAnesthesiology\u003C\/em\u003E. 2012]. Patients with intraoperative train\u2013of\u2013four (TOF) monitoring of eye muscles had a significantly greater incidence of residual paralysis than patients monitored at the adductor pollicis (\u003Cem\u003EP\u003C\/em\u003E \u0026lt; .01). Residual paralysis was seen in 52% and 22% of patients, respectively. In both cases, TOF was \u0026lt; 0.9.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EAnother study evaluated the efficacy of 20 vs 40 \u03bcg\/kg of neostigmine in 60 patients who received a single intubating dose of vecuronium [Caldwell JE. \u003Cem\u003EAnesth Analg.\u003C\/em\u003E 1995]. One to 4 hours later, TOF ratios decreased in 8 patients. All had a TOF ratio \u2265 0.9 and received 40 \u03bcg\/kg. The incidence of cardiovascular effects was high (50%) after both doses (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/40\/23\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Reversal of Residual Neuromuscular Block With Neostigmine\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1220557853\u0022 data-figure-caption=\u0022Reversal of Residual Neuromuscular Block With Neostigmine\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/40\/23\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/40\/23\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/40\/23\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15107\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003EReversal of Residual Neuromuscular Block With Neostigmine\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003ETOF, train\u2013of\u2013four.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced from Caldwell JE. Reversal of residual neuromuscular block with neostigmine at one to four hours after a single intubating dose of vecuronium. Anesth Analg. 1995;80:1168\u20131174. With permission from International Anesthesia Research Society.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-7\u0022\u003EThe introduction of sugammadex into clinical practice has revolutionized the way that anesthesiologists think about drug reversal [Schaller SJ, Fink H. \u003Cem\u003ECore Evid.\u003C\/em\u003E 2013]. As the first cyclodextrin to be used as a therapeutic agent, it quickly, effectively, and safely reverses steroidal neuromuscular blockers by encapsulating the muscle relaxant and rendering it inactive [Jahr JS et al. \u003Cem\u003EAm J Ther.\u003C\/em\u003E 2014].\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003ESince its approval in Europe in 2008, thousands of doses have been given. The drug has been used extensively across a range of special populations\u2014including pregnant women, elderly individuals, and patients with myasthenia gravis [Schaller SJ, Fink H. \u003Cem\u003ECore Evidence.\u003C\/em\u003E 2013]\u2014with no unexpected adverse reactions [Gold SJA, Harper NJN. \u003Cem\u003ETrends in Anesthesia and Critical Care.\u003C\/em\u003E 2012].\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EAmong those with morbid obesity, sugammadex enabled a safer and faster recovery from profound rocuronium\u2013induced neuromuscular blocking than neostigmine (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E) [Carron M et al. \u003Cem\u003EObes Surg.\u003C\/em\u003E 2013]. Another investigation found that pretreatment with a single intravenous dose of magnesium (60 mg\/kg) did not decrease the efficacy of sugammadex for the reversal of a moderate and deep neuromuscular block induced by an intubation dose of rocuronium [Czarnetzki C et al. \u003Cem\u003EAnesthesiology\u003C\/em\u003E. 2014].\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/15108\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/15108\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15108\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-10\u0022 class=\u0022first-child\u0022\u003EAnesthetics, Anesthesiology, and Surgical Times by Group\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-14\u0022\u003ESugammadex is a fast, potent, and safe reversal agent for aminosteroid muscle relaxants. Although it has yet to be approved by the US Food and Drug Administration, it clearly has the potential to be a worldwide game changer in the practice of anesthesia.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/40\/23.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzon01\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzon01\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzon01\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}