Schaller Stefan Josef, Fink Heidrun
Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany ; Department of Anesthesia, Massachusetts General Hospital, Boston, MA, USA.
Core Evid. 2013;8:57-67. doi: 10.2147/CE.S35675. Epub 2013 Sep 25.
Sugammadex is the first clinical representative of a new class of drugs called selective relaxant binding agents. It has revolutionized the way anesthesiologists think about drug reversal. Sugammadex selectively binds rocuronium or vecuronium, thereby reversing their neuromuscular blocking action. Due to its 1:1 binding of rocuronium or vecuronium, it is able to reverse any depth of neuromuscular block. So far, it has been approved for use in adult patients and for pediatric patients over 2 years. Since its approval in Europe, Japan, and Australia, further insight on its use in special patient populations and specific diseases have become available. Due to its pharmacodynamic profile, sugammadex, in combination with rocuronium, may have the potential to displace succinylcholine as the "gold standard" muscle relaxant for rapid sequence induction. The use of rocuronium or vecuronium, with the potential of reverse of their action with sugammadex, seems to be safe in patients with impaired neuromuscular transmission, ie, neuromuscular diseases, including myasthenia gravis. Data from long-term use of sugammadex is not yet available. Evidence suggesting an economic advantage of using sugammadex and justifying its relatively high cost for an anesthesia-related drug, is missing.
舒更葡糖钠是一类名为选择性肌松药结合剂的新型药物中的首个临床代表药物。它彻底改变了麻醉医生对药物逆转的看法。舒更葡糖钠选择性地结合罗库溴铵或维库溴铵，从而逆转它们的神经肌肉阻滞作用。由于它与罗库溴铵或维库溴铵以1:1的比例结合，所以能够逆转任何深度的神经肌肉阻滞。到目前为止，它已被批准用于成年患者以及2岁以上的儿科患者。自其在欧洲、日本和澳大利亚获批以来，关于其在特殊患者群体和特定疾病中的应用有了更多见解。鉴于其药效学特性，舒更葡糖钠与罗库溴铵联合使用，可能有潜力取代琥珀酰胆碱，成为快速顺序诱导的“金标准”肌肉松弛剂。对于神经肌肉传递受损的患者，即患有包括重症肌无力在内的神经肌肉疾病的患者，使用罗库溴铵或维库溴铵并有可能用舒更葡糖钠逆转其作用似乎是安全的。目前尚无舒更葡糖钠长期使用的数据。缺乏表明使用舒更葡糖钠具有经济优势并能证明其作为一种麻醉相关药物成本相对较高合理的证据。
