Reversing neuromuscular blockade: inhibitors of the acetylcholinesterase versus the encapsulating agents sugammadex and calabadion

Expert Opinion on Pharmacotherapy
Friederike Haerter, Matthias Eikermann

Abstract

Acetylcholinesterase inhibitors (neostigmine, edrophonium) and encapsulating agents (sugammadex and calabadion) can be used to reverse residual neuromuscular blockade (NMB). This review provides information about efficacy, effectiveness, and side effects of drugs (acetylcholinesterase inhibitors and encapsulating agents) used to reverse neuromuscular blocking agents (NMBAs). The therapeutic range of acetylcholinesterase-inhibitors is narrow and effectiveness studies demonstrate clinicians don't use these unspecific reversal agents effectively to increase postoperative respiratory safety. The encapsulating drugs sugammadex and calabadion reverse all levels of NMB, and complete recovery of muscle strength can be achieved almost immediately after administration. For this reason encapsulating agents can be used as a solution for "cannot intubate cannot ventilate"- situations. Poor binding selectivity of encapsulating agents carries the risk of displacement of the NMBA by a competitively binding drug, which may lead to recurarization. In order to avoid side-effects, related to unspecific binding of endogenous proteins and drugs administered perioperatively it is prudent to titrate the dose of reversal agents to the minimal effective...Continue Reading

References

Mar 1, 1988·Anaesthesia·R M SlaterB R Doran
Feb 1, 1987·Journal of Dental Research·M M Schubert, K T Izutsu
Mar 1, 1988·Anaesthesia·C I Pratt
Jan 1, 1986·British Journal of Anaesthesia·S Ward, B C Weatherley
Jul 1, 1972·Canadian Anaesthetists' Society Journal·S RamamurthyA P Winnie
Jun 1, 1966·British Journal of Anaesthesia·M E Barrow, J K Johnson
Jan 1, 1982·British Journal of Anaesthesia·D R BevanB D Higgs
Jul 1, 1980·Clinical Pharmacology and Therapeutics·R CronnellyL B Sheiner
Nov 4, 2000·Neurochemical Research·R JanákyS S Oja
Dec 26, 2001·Anesthesiology·Hans KirkegaardJames E Caldwell
May 10, 2002·European Journal of Anaesthesiology·G CammuE Mortier
Feb 4, 2003·Nature Reviews. Neuroscience·Sultan DarveshChangiz Geula
Mar 7, 2003·European Journal of Pharmacology·Altaf S Darvesh, Gary A Gudelsky
Apr 30, 2003·Anesthesiology·Thomas MenckeThomas Fuchs-Buder
Sep 1, 1952·British Journal of Pharmacology and Chemotherapy·R I BODMAN
Oct 25, 1952·British Medical Journal·T C GRAY, G J REES
Jul 1, 1959·Anesthesiology·T C GRAY, F WILSON
Mar 1, 1963·Canadian Anaesthetists' Society Journal·J D GOTTLIEB, R B SWEET
Mar 1, 1965·Anesthesiology·H C CHURCHILL-DAVIDSON
Apr 17, 2004·Anesthesiology·Matthew R BelmontJohn J Savarese
Feb 1, 2005·Anesthesiology·M Sesmu ArbousDiederick E Grobbee
Sep 27, 2005·British Journal of Anaesthesia·C BaillardC M Samama
Oct 26, 2005·Anesthesia and Analgesia·Ching-Rong ChengChristian C Apfel
Jan 26, 2006·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Guillaume TragerThomas M Hemmerling
Oct 7, 2006·American Journal of Respiratory and Critical Care Medicine·Matthias EikermannJürgen Peters
Jan 2, 2007·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Thomas M Hemmerling, Nhien Le

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Citations

Jul 28, 2016·Expert Opinion on Drug Metabolism & Toxicology·Stefan Josef Schaller, Heidrun Lewald
Mar 3, 2018·AACN Advanced Critical Care·Nicole Stawicki, Patty Gessner
Jun 16, 2018·Current Anesthesiology Reports·Hans Donald de Boer, Ricardo Vieira Carlos
Oct 31, 2019·Anesthesia and Pain Medicine·Jin Sun KimHong Seuk Yang

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