Cammu Guy
Anesthesiology and Critical Care Medicine, Onze-Lieve-Vrouw Ziekenhuis, Moorselbaan 164, 9300 Aalst, Belgium.
Curr Anesthesiol Rep. 2018;8(2):178-185. doi: 10.1007/s40140-018-0265-6. Epub 2018 Mar 20.
The purpose of this review is to assess how sugammadex impacts postoperative residual curarization using appropriate doses based on neuromuscular transmission monitoring and whether the advantages of sugammadex versus neostigmine outweigh its higher cost.
An accurate assessment of neuromuscular blockade with monitoring is necessary before selecting neostigmine versus sugammadex for reversal at the end of surgery to overcome incomplete neuromuscular recovery. The main advantages of sugammadex over neostigmine are its predictability and its ability to extend the range of blockade reversal. The cost of sugammadex is greater when higher doses of sugammadex are required for antagonism of deep block. Sugammadex probably has the potential to be cost-effective compared with neostigmine if its time savings are put to productive use in clinical practice. However, to date, the economic benefits of the drug are unknown.
With sugammadex, almost any degree of neuromuscular block can be antagonized within 2-3 min; neostigmine is the only reversal agent effective against benzylisoquinolines and can ideally be used for reversal of lower levels of residual paralysis. The performance of the more expensive sugammadex on improving patient outcomes may depend on several elements of clinical strategy.
本综述旨在评估舒更葡糖基于神经肌肉传递监测使用适当剂量时对术后残余肌松的影响，以及舒更葡糖与新斯的明相比，其优势是否超过更高的成本。
在手术结束时选择新斯的明还是舒更葡糖进行逆转以克服神经肌肉恢复不完全之前，有必要通过监测对神经肌肉阻滞进行准确评估。舒更葡糖相对于新斯的明的主要优势在于其可预测性以及扩大阻滞逆转范围的能力。当需要更高剂量的舒更葡糖来拮抗深度阻滞时，其成本更高。如果舒更葡糖节省的时间能在临床实践中得到有效利用，那么与新斯的明相比，它可能具有成本效益。然而，迄今为止，该药物的经济效益尚不清楚。
使用舒更葡糖，几乎任何程度的神经肌肉阻滞都可在2 - 3分钟内得到拮抗；新斯的明是唯一对苄基异喹啉有效的逆转剂，理想情况下可用于逆转较低程度的残余麻痹。更昂贵的舒更葡糖在改善患者预后方面的表现可能取决于临床策略的几个要素。
