Sugammadex: su eficacia y seguridad en la reversión selectiva del vecuronio

Autor: Morales Escobar, Viviana
Přispěvatelé: Santacruz Escudero, Carlos Miguel
Jazyk: Spanish; Castilian
Rok vydání: 2013
Předmět:
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Repositorio EdocUR-U. Rosario
Universidad del Rosario
instacron:Universidad del Rosario
DOI: 10.48713/10336_4346
Popis: Introducción: En 1979, con la monitorización del uso rutinario de los relajantes neuromusculares, se determinó incidencia en la relajación neuromuscular residual del 45%, con múltiples complicaciones respiratorias que incrementan la estancia hospitalaria. No es conocida la eficacia y seguridad del manejo del vecuronio y su reversión con el uso del sugammadex dentro del manejo rutinario de anestesia. Métodos: Revisión sistemática de artículos sobre el comportamiento del sugammadex cuando se realiza reversión para el efecto del vecuronio, por ser la primera droga que ha demostrado eficacia y seguridad frente a relajantes musculares no despolarizantes esteroideos, que ayuda a prevenir bloqueo residual en el posoperatorio. Resultados: Búsqueda en las bases de datos de EMBASE, EBSCO y MEDLINE y Pubmed (desde enero 2000-diciembre 2012), con palabras MeSH, sugammadex, vecuronium, binding reversal agents, neuromuscular blocking agents; artículos en idioma inglés de estudios clínicos controlados en pacientes humanos adultos en los cuales el sugammadex fue comparado con placebo u otro medicamento. Se aprecia disminución del tiempo de recuperación de la relajación neuromuscular en el bloqueo moderado con un rango de 1,5 a 2,3min con el sugammadex vs 18,9 a 66,2min con la neostigmine y en un bloqueo profundo desde 35,5-68,4min, con dosis de 0,5mgrs/kg de sugammadex hasta 1,4-1,7min con 8mgrs/kg. Discusión: Resultados favorables en el suministro de dosis mayores a 2mgrs/kg en pacientes que presentaban bloqueo neuromuscular moderado y mayores de 4mgrs/kg en bloqueo neuromuscular profundo. Existe necesidad de nuevos estudios clínicos que soporten estos hallazgos. Conclusión: La evidencia sugiere que sí existe una adecuada reversión de la relajación neuromuscular del vecuronio con el uso de sugammadex a 2mgrs/kg, con disminución importante del tiempo y mayor recuperación del paciente sin presencia de relajación residual. Introduction: With the regular use of muscle relaxants (neuromuscular blockade) agentssince 1942 and later examination in 1979, a high incidence of residual neuromuscularblockade was established up to 45% with 0. 9 of TOF. Moreover this is also related withmultiple breathing complications increasing hospital stay in immediately postoperativepatients. Methods: Systematic review of scientific literature providing information about responseto sugammadex when used to reverse vecuronium`s effects, due to being the first drug thathas demonstrated efficiency and safety in reversion of non-depolarizing steroid relaxants, helping to prevent postoperative residual blockade. Results: A research was carried out by using EMBASE, EBSCO and MEDLINEdatabases, with time scope from January 2000 to December 2012, using MeSH, sugammadex and vecuronium as keywords. A set of clinical controlled trials papersconcerning sugammadex comparisons versus placebo or other drugs were established, forhuman adults over 18 years old. As a result there is a significant time reduction in moderateneuromuscular blockade recovery ranging from 1. 5 to 2. 3 minutes with sugammadex incontrast with neostigmine with a 18. 9 to 66. 2 minutes average. For deep blockadesugammadex recovery results were found ranging from 35. 5-68. 4 minutes with 0. 5milligrams per Kg doses up to 1. 4-1. 7 with 8 milligrams per Kg. Discussion: Favorable results were achieved when using higher doses to 2 milligrams perKg. in moderate neuromuscular blockade patients, and higher doses to 4 milligrams per Kg. for deep blockade. Conclusions: Evidence suggests that there is in fact an adequate reversion of vecuroniumneuromuscular blockade effects when using sugammadex, with significant time decreaseand higher patient recovery rate without residual blockade or recurarization.
Databáze: OpenAIRE