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Bridion® in Clinical Practice: Case Study Dr Robin Duckworth Consultant Anaesthetist Ross Hall Hospital, Glasgow The views and opinions expressed in this.

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Presentation on theme: "Bridion® in Clinical Practice: Case Study Dr Robin Duckworth Consultant Anaesthetist Ross Hall Hospital, Glasgow The views and opinions expressed in this."— Presentation transcript:

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2 Bridion® in Clinical Practice: Case Study Dr Robin Duckworth Consultant Anaesthetist Ross Hall Hospital, Glasgow The views and opinions expressed in this presentation are not those of Schering-Plough Corporation SUG/09-183

3 Aims 2 case presentations commentary and impressions of using sugammadex

4 Case Study 1 elective admission for bilateral thoracoscopic sympathectomy 21 year old female 5’3” and 65kg ( BMI 26 )

5 Case Study 1 PMH –Irritable bowel –Asthma –Tonsillectomy colonoscopy laryngoscopy non smoker allergic to Penicillin no medication ASA grade 1

6 Case Study 1 anaesthesia: –propofol 200mg –alfentanil 1mg –vecuronium 6mg –oxygen/air mix –sevoflurane –fentanyl 50mcg

7 Case Study 1 direct laryngoscopy – grade 1 laryngoscopy demonstrated a large exophytic friable lesion with surface ulceration at the base of the tongue biopsies were taken

8 Case Study 1 Reversal –a period of 15 minutes had elapsed –sugammadex 200mg

9 Case Study 1 spontaneous respiration returned over the next minute patient extubated rapidly verbalising almost immediately no recall

10 Case Study 2 71 year old male elective admission for lumbar decompression and Wallis stabilization 5’9” and 68kg (BMI 32) ASA 1 No past medical history No known allergy

11 Case Study 2 anaesthesia –propofol 180mg –alfentanil 0.9mg –N2O/O2/Desflurane –vecuronium 6mg –fentanyl 150mcg –cefuroxime 1.5G –ondansetron 8mg –cyclimorph 7.5mg –diclofenac 75mg

12 Case Study 2 reversal after 65 minutes –neostigmine 3.75mg –glycopyrrolate 0.75mg

13 Case Study 2 extubated in recovery 5 minutes later patient now stridulous and agitated not able to verbalise adequately appearance was of inadequate reversal

14 Case Study 2 what next ? –wait –monitor –further reversal –sugammadex...

15 Case Study 2...within 30 seconds –stridor abolished –sitting up –verbalising coherently

16 Scenarios a standard reversal the special situation - eg ultra short inadequate reversal other possible benefits – real or perceived relaxant anaphylaxis

17 Sugammadex Standard reversal speed – rapid return of spontaneous respiration, obviates the need for further doses of reversal head lift – as a monitor of recovery is a thing of the past! cough reflex – never any apparent residual curarization, if the correct dosing adhered to muscle tone – appears to return to preoperative levels re-animation occurs!

18 Sugammadex Special situations short and ultra short, bariatric procedures surgical relaxation – optimizing relaxation eg for closure or at specific times during surgery failed intubation – with or without airway expected and unexpected clinical scenario

19 Sugammadex Inadequate reversal conventional failure PORC does not appear to occur clinically when sugammadex is given in the recommended dose muscle power returns to pre-surgery levels

20 Sugammadex Benefits – real and perceived aspiration less likely immediate post-operative pulmonary complications less likely co-operative patients with excellent muscle tone calmer more “settled” patients possibly due to lack of PORC lack of side effects such as tachycardia, bronchospasm, nausea

21 Sugammadex Benefits – cont. optimizing relaxation for closure – improves surgical closure?, dehiscence less likely?, herniation less? increased flexibility of technique pain control more manageable in immediate recovery period happier surgeon

22 Sugammadex Relaxant anaphylaxis Rocuronium or vecuronium – the concept of its use as immediate, perhaps first line treatment

23 Sugammadex Summary Bridion is a new and novel drug which due its unique pharmacology provides anaesthetists with an agent which, in my view, surpasses our present ability to reverse most levels of relaxant blockade rapidly, safely, and in my view much more effectively than ever before

24 Sugammadex This results in a happier surgeon confident anaesthetist much safer patient

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