Maqusood Shafaque, Bele Amol, Verma Neeta, Dash Sambit, Bawiskar Dushyant
Anaesthesiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND.
Sports Medicine, Abhinav Bindra Targeting Performance, Bangalore, IND.
Cureus. 2024 Jul 29;16(7):e65656. doi: 10.7759/cureus.65656. eCollection 2024 Jul.
The use of neuromuscular blocking agents (NMBA) has grown due to the development of laparoscopic and minimally invasive procedures. Respiratory insufficiency, an elevated risk of aspiration, postoperative pulmonary complications, and subsequent reintubation are among the risks linked to the residual block. The normal clinical practice calls for the pharmacologic "reversal" of these agents with either sugammadex or neostigmine prior to extubation. The administration of neostigmine is linked to a number of potential complications. In response, anaesthesiologists have begun to prescribe sugammadex more frequently for treating residual block and reversing blockade with NMBA. This review article compares and assesses neostigmine and sugammadex thoroughly in order to determine the extent to which they work as agents to reverse neuromuscular blockade. The review's findings highlight sugammadex's considerable advantages - Sugammadex's ability to quickly and reliably achieve desired train-of-four (TOF) ratios - over neostigmine in reversing neuromuscular blockade in a variety of surgical settings. In contrast, neostigmine's limitations regarding efficacy and rate of reversal were consistently noted in all of the reviewed studies, despite the fact that it is still widely used due to its lower cost and extensive clinical experience. Sugammadex is a superior option for reversing neuromuscular blockade, but incorporating it into standard clinical practice necessitates carefully weighing its potential benefits and drawbacks. Sugammadex provides notable benefits over neostigmine in terms of speed, predictability, and safety.
由于腹腔镜手术和微创手术的发展，神经肌肉阻滞剂（NMBA）的使用有所增加。呼吸功能不全、误吸风险升高、术后肺部并发症以及随后的再次插管都是与残余肌松相关的风险。正常临床实践要求在拔管前使用舒更葡糖或新斯的明对这些药物进行药理学“逆转”。新斯的明的使用与一些潜在并发症有关。作为回应，麻醉医生开始更频繁地开舒更葡糖来治疗残余肌松和逆转NMBA引起的肌松。这篇综述文章对新斯的明和舒更葡糖进行了全面比较和评估，以确定它们作为逆转神经肌肉阻滞药物的作用程度。该综述的结果突出了舒更葡糖的显著优势——在各种手术环境中，舒更葡糖在逆转神经肌肉阻滞方面比新斯的明能够更快、更可靠地达到所需的四个成串刺激（TOF）比值。相比之下，尽管新斯的明因其成本较低和广泛的临床经验仍被广泛使用，但在所有综述研究中都一致指出了其在疗效和逆转速度方面的局限性。舒更葡糖是逆转神经肌肉阻滞的更优选择，但将其纳入标准临床实践需要仔细权衡其潜在的利弊。在速度、可预测性和安全性方面，舒更葡糖比新斯的明具有显著优势。
