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

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 non smoker allergic to Penicillin no medication
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 10

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

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

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 13

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