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Sugammadex

January 01, 1970

Sugammadex, sold under the brand name Bridion, is a medication for the reversal of neuromuscular blockade induced by rocuronium and vecuronium[5] in general anaesthesia. It is the first selective relaxant binding agent (SRBA). It is marketed by Merck.[8]

Sugammadex
Clinical data
Pronunciationsoo GAM ma dex
Trade namesBridion
Other namesORG-25969
AHFS/Drugs.comMonograph
License data
Pregnancy
category
  • AU: B2
Routes of
administration		Intravenous
ATC code
Legal status
Legal status
Identifiers
CAS Number
  • 343306-71-8 N
PubChem CID
  • 6918585
  • as salt: 6918584
DrugBank
  • DB06206 Y
ChemSpider
  • 32689915 N
UNII
  • 361LPM2T56
  • as salt: ERJ6X2MXV7 Y
KEGG
  • as salt: D05940 Y
ChEBI
  • CHEBI:90953 N
  • as salt: CHEBI:90952 N
ChEMBL
  • ChEMBL2111107
  • as salt: ChEMBL2107374
ECHA InfoCard100.121.931
Chemical and physical data
FormulaC72H112O48S8
Molar mass2002.12 g·mol−1
3D model (JSmol)
  • Interactive image
  • O=C(O)CCSC[C@H]1O[C@@H]2O[C@@H]3[C@@H](CSCCC(=O)O)O[C@H](O[C@@H]4[C@@H](CSCCC(=O)O)O[C@H](O[C@@H]5[C@@H](CSCCC(=O)O)O[C@H](O[C@@H]6[C@@H](CSCCC(=O)O)O[C@H](O[C@@H]7[C@@H](CSCCC(=O)O)O[C@H](O[C@@H]8[C@@H](CSCCC(=O)O)O[C@H](O[C@@H]9[C@@H](CSCCC(=O)O)O[C@H](O[C@H]1[C@H](O)[C@H]2O)[C@H](O)[C@H]9O)[C@H](O)[C@H]8O)[C@H](O)[C@H]7O)[C@H](O)[C@H]6O)[C@H](O)[C@H]5O)[C@H](O)[C@H]4O)[C@H](O)[C@H]3O
  • InChI=1S/C72H112O48S8/c73-33(74)1-9-121-17-25-57-41(89)49(97)65(105-25)114-58-26(18-122-10-2-34(75)76)107-67(51(99)43(58)91)116-60-28(20-124-12-4-36(79)80)109-69(53(101)45(60)93)118-62-30(22-126-14-6-38(83)84)111-71(55(103)47(62)95)120-64-32(24-128-16-8-40(87)88)112-72(56(104)48(64)96)119-63-31(23-127-15-7-39(85)86)110-70(54(102)46(63)94)117-61-29(21-125-13-5-37(81)82)108-68(52(100)44(61)92)115-59-27(19-123-11-3-35(77)78)106-66(113-57)50(98)42(59)90/h25-32,41-72,89-104H,1-24H2,(H,73,74)(H,75,76)(H,77,78)(H,79,80)(H,81,82)(H,83,84)(H,85,86)(H,87,88)/t25-,26-,27-,28-,29-,30-,31-,32-,41-,42-,43-,44-,45-,46-,47-,48-,49-,50-,51-,52-,53-,54-,55-,56-,57-,58-,59-,60-,61-,62-,63-,64-,65-,66-,67-,68-,69-,70-,71-,72-/m1/s1 N
  • Key:WHRODDIHRRDWEW-VTHZAVIASA-N N
 NY (what is this?)  (verify)

The most common side effects include cough, airway problems due to the anaesthesia wearing off, reduced blood pressure and other complications such as changes in heart rate.[6]

Sugammadex is available as a generic medication.[9]

Medical uses edit

Sugammadex is indicated for the reversal of neuromuscular blockade induced by rocuronium or vecuronium.[5][6]

Pharmacology edit

Pharmacodynamics edit

Sugammadex is a modified γ-cyclodextrin, with a lipophilic core and a hydrophilic periphery. This gamma cyclodextrin has been modified from its natural state by placing eight carboxyl thio ether groups at the sixth carbon positions. These extensions extend the cavity size allowing greater encapsulation of the rocuronium molecule. These negatively charged extensions electrostatically bind to the quaternary nitrogen of the target as well as contribute to the aqueous nature of the cyclodextrin. Sugammadex's binding encapsulation of rocuronium is one of the strongest among cyclodextrins and their guest molecules. The rocuronium molecule (a modified steroid) bound within sugammadex's lipophilic core, is rendered unavailable to bind to the acetylcholine receptor at the neuromuscular junction.

 
 
Left: Schematic of a sugammadex molecule encapsulating a rocuronium molecule.
Right: Space-filling model of a sugammadex sodium molecule in the same orientation.


Sugammadex, unlike neostigmine, does not inhibit acetylcholinesterase so cholinergic effects are not produced and co-administration of an antimuscarinic agent (glycopyrronium bromide or atropine) is not needed. Sugammadex might therefore be expected to have fewer adverse effects than the traditional reversal agents.

When muscle relaxant with rapid onset and short duration of action is required, there has been little choice apart from succinylcholine but this drug has important contraindications; for example, it can trigger malignant hyperthermia in susceptible individuals, it has a prolonged duration of action in patients with pseudocholinesterase deficiency and it causes an increase in plasma potassium concentration which is dangerous in some circumstances. Rocuronium has a comparably quick onset in high dose (0.6 mg kg−1 to 1 mg kg−1) and can be rapidly reversed with sugammadex (16 mg kg−1), so this drug combination offers an alternative to suxamethonium.

'Recurarisation', a phenomenon of recurrence of neuromuscular block, may occur where the reversal agents wear off before a neuromuscular blocking drug is completely cleared. This is very unusual with all but the longest acting neuromuscular blocking drugs (such as gallamine, pancuronium or tubocurarine). It has been demonstrated to occur only rarely with sugammadex, and only when insufficient doses were administered.[10] The underlying mechanism is thought to be related to redistribution of relaxant after reversal. It may occur for a limited range of sugammadex doses which are sufficient for complex formation with relaxant in the central compartment, but insufficient for additional relaxant returning to central from peripheral compartments.[11]

Sugammadex has been shown to have affinity for two other aminosteroid neuromuscular blocking agents, vecuronium and pancuronium. Although sugammadex has a lower affinity for vecuronium than for rocuronium, reversal of vecuronium is still effective because fewer vecuronium molecules are present in vivo for equivalent blockade: vecuronium is approximately seven times more potent than rocuronium. Sugammadex encapsulates with a 1:1 ratio and therefore will adequately reverse vecuronium as there are fewer molecules to bind compared to rocuronium.[12] Shallow pancuronium blockade has been successfully reversed by sugammadex in phase III clinical trials.[13]

Efficacy edit

A study was carried out in Europe looking at its suitability in rapid sequence induction. It found that sugammadex provides a rapid and dose-dependent reversal of neuromuscular blockade induced by high-dose rocuronium.[14]

A Cochrane review on sugammadex concluded that "sugammadex was shown to be more effective than placebo (no medication) or neostigmine in reversing muscle relaxation caused by neuromuscular blockade during surgery and is relatively safe. Serious complications occurred in less than 1% of the patients who received sugammadex. The results of this review article (especially the safety results) need to be confirmed by future trials on larger patient populations".[15] The 2017 Cochrane review concluded that sugammadex has a better safety profile than neostigmine with 40% fewer adverse events.[16] Specifically the risks of postoperative residual paralysis, bradycardia, nausea and vomiting are reduced if sugammadex is used as a reversal agent. The British Journal of Anaesthesia published an article in 2015 in which the incidence of residual neuromuscular blockade could be reduced to zero if sugammadex is used as the reversal agent and the correct dosage is selected with the use of neuromuscular monitoring.[17] Also when the reversal times of each agent were compared "Data indicate that sugammadex was 10.22 minutes (6.6 times) faster than neostigmine (1.96 vs 12.87 minutes) in reversing moderate induced paralysis. Sugammadex was 45.78 minutes (16.8 times) faster than neostigmine (2.9 vs 48.8 minutes) in reversing deep induced paralysis."[16] The time saved by rapid reversal and the reduction of postoperative residual paralysis may reduce the overall hospital costs and provide significant improvements in patient safety.[citation needed]

Tolerability edit

Sugammadex was generally well tolerated in clinical trials in surgical patients or healthy volunteers. In pooled analyses, the tolerability profile of sugammadex was generally similar to that of placebo or neostigmine plus glycopyrrolate.[18] Sugammadex may theoretically interfere with hormonal contraceptives due to evidence from in vitro binding studies which showed it may bind to progestogen.[5]

History edit

Sugammadex was discovered by the pharmaceutical company Organon at the Newhouse Research Site in Scotland.[19] Organon was acquired by Schering-Plough in 2007; Schering-Plough merged with Merck in 2009. Sugammadex is now owned and sold by Merck.

The US Food and Drug Administration (FDA) initially rejected Schering-Plough's New Drug Application for sugammadex in 2008,[20] but finally approved the medication for use in the United States in December 2015.[21][22] Sugammadex was approved for use in the European Union in July 2008.[6][23]

References edit

  1. ^ SUGAMMADEX ACCORD (Accord Healthcare Pty Ltd) 2022-10-12 at the Wayback Machine Department of Health and Aged Care. Retrieved 30 March 2023
  2. ^ SUGAMMADEX SANDOZ (Sandoz Pty Ltd) 2022-10-12 at the Wayback Machine Department of Health and Aged Care. Retrieved 30 March 2023
  3. ^ "Health Canada New Drug Authorizations: 2016 Highlights". Health Canada. 14 March 2017. Retrieved 7 April 2024.
  4. ^ "Bridion 100 mg/ml solution for injection - Summary of Product Characteristics (SmPC)". (emc). 18 March 2021. from the original on 27 June 2021. Retrieved 27 June 2021.
  5. ^ a b c d "Bridion- sugammadex injection, solution". DailyMed. 14 December 2018. from the original on 10 June 2020. Retrieved 10 June 2020.
  6. ^ a b c d "Bridion EPAR". European Medicines Agency (EMA). 17 September 2018. from the original on 10 June 2020. Retrieved 10 June 2020. Text was copied from this source which is © European Medicines Agency. Reproduction is authorized provided the source is acknowledged.
  7. ^ "Sugammadex Adroiq". Union Register of medicinal products. 30 May 2023. Retrieved 6 June 2023.
  8. ^ "Dosing for Bridion (sugammadex)". www.merckconnect.com. from the original on 2019-01-12. Retrieved 2019-01-11.
  9. ^ "Sugammadex Adroiq". European Medicines Agency. 16 June 2023. Retrieved 19 June 2023.
  10. ^ Miller RD (March 2007). "Sugammadex: an opportunity to change the practice of anesthesiology?". Anesthesia and Analgesia. 104 (3): 477–478. doi:10.1213/01.ane.0000255645.64583.e8. PMID 17312188.
  11. ^ Eleveld DJ, Kuizenga K, Proost JH, Wierda JM (March 2007). "A temporary decrease in twitch response during reversal of rocuronium-induced muscle relaxation with a small dose of sugammadex". Anesthesia and Analgesia. 104 (3): 582–584. doi:10.1213/01.ane.0000250617.79166.7f. PMID 17312212. S2CID 34811540.
  12. ^ Welliver M (October 2006). "New drug sugammadex: a selective relaxant binding agent". AANA Journal. 74 (5): 357–363. PMID 17048555.
  13. ^ Decoopman M (2007). "Reversal of pancuronium-induced block by the selective relaxant binding agent sugammadex". Eur J Anaesthesiol. 24(Suppl 39):110-111.
  14. ^ Pühringer FK, Rex C, Sielenkämper AW, Claudius C, Larsen PB, Prins ME, et al. (August 2008). "Reversal of profound, high-dose rocuronium-induced neuromuscular blockade by sugammadex at two different time points: an international, multicenter, randomized, dose-finding, safety assessor-blinded, phase II trial". Anesthesiology. 109 (2): 188–197. doi:10.1097/ALN.0b013e31817f5bc7. PMID 18648227.
  15. ^ Abrishami A, Ho J, Wong J, Yin L, Chung F (October 2009). Abrishami A (ed.). "Sugammadex, a selective reversal medication for preventing postoperative residual neuromuscular blockade". The Cochrane Database of Systematic Reviews (4): CD007362. doi:10.1002/14651858.CD007362.pub2. PMID 19821409.
  16. ^ a b Hristovska AM, Duch P, Allingstrup M, Afshari A (August 2017). "Efficacy and safety of sugammadex versus neostigmine in reversing neuromuscular blockade in adults". The Cochrane Database of Systematic Reviews. 8 (8): CD012763. doi:10.1002/14651858.cd012763. PMC 6483345. PMID 28806470.
  17. ^ Brueckmann B, Sasaki N, Grobara P, Li MK, Woo T, de Bie J, et al. (November 2015). "Effects of sugammadex on incidence of postoperative residual neuromuscular blockade: a randomized, controlled study". British Journal of Anaesthesia. 115 (5): 743–751. doi:10.1093/bja/aev104. PMID 25935840.
  18. ^ Yang LP, Keam SJ (2009). "Sugammadex: a review of its use in anaesthetic practice". Drugs. 69 (7): 919–942. doi:10.2165/00003495-200969070-00008. PMID 19441874. S2CID 195685307. from the original on 2011-10-08. Retrieved 2010-03-29.
  19. ^ Naguib M (March 2007). "Sugammadex: another milestone in clinical neuromuscular pharmacology". Anesthesia and Analgesia. 104 (3): 575–581. doi:10.1213/01.ane.0000244594.63318.fc. PMID 17312211.
  20. ^ (Press release). Schering-Plough. 2008-08-01. Archived from the original on 2008-08-10. Retrieved 2008-08-02.
  21. ^ "Bridion (sugammadex) Injection". U.S. Food and Drug Administration (FDA). 4 February 2016. from the original on 10 June 2020. Retrieved 10 June 2020.
  22. ^ (Press release). Food and Drug Administration. 2015-12-15. Archived from the original on 2015-12-15. Retrieved 2015-12-15.
  23. ^ (Press release). Schering-Plough. 2008-07-29. Archived from the original on 2008-09-24. Retrieved 2008-08-02.

January 01, 1970
sugammadex, sold, under, brand, name, bridion, medication, reversal, neuromuscular, blockade, induced, rocuronium, vecuronium, general, anaesthesia, first, selective, relaxant, binding, agent, srba, marketed, merck, clinical, datapronunciationsoo, dextrade, na. Sugammadex sold under the brand name Bridion is a medication for the reversal of neuromuscular blockade induced by rocuronium and vecuronium 5 in general anaesthesia It is the first selective relaxant binding agent SRBA It is marketed by Merck 8 SugammadexClinical dataPronunciationsoo GAM ma dexTrade namesBridionOther namesORG 25969AHFS Drugs comMonographLicense dataUS DailyMed SugammadexPregnancycategoryAU B2Routes ofadministrationIntravenousATC codeV03AB35 WHO Legal statusLegal statusAU S4 Prescription only 1 2 CA only 3 UK POM Prescription only 4 US only 5 EU Rx only 6 7 In general Prescription only IdentifiersCAS Number343306 71 8 NPubChem CID6918585as salt 6918584DrugBankDB06206 YChemSpider32689915 NUNII361LPM2T56as salt ERJ6X2MXV7 YKEGGas salt D05940 YChEBICHEBI 90953 Nas salt CHEBI 90952 NChEMBLChEMBL2111107as salt ChEMBL2107374ECHA InfoCard100 121 931Chemical and physical dataFormulaC 72H 112O 48S 8Molar mass2002 12 g mol 13D model JSmol Interactive imageSMILES O C O CCSC C H 1O C H 2O C H 3 C H CSCCC O O O C H O C H 4 C H CSCCC O O O C H O C H 5 C H CSCCC O O O C H O C H 6 C H CSCCC O O O C H O C H 7 C H CSCCC O O O C H O C H 8 C H CSCCC O O O C H O C H 9 C H CSCCC O O O C H O C H 1 C H O C H 2O C H O C H 9O C H O C H 8O C H O C H 7O C H O C H 6O C H O C H 5O C H O C H 4O C H O C H 3OInChI InChI 1S C72H112O48S8 c73 33 74 1 9 121 17 25 57 41 89 49 97 65 105 25 114 58 26 18 122 10 2 34 75 76 107 67 51 99 43 58 91 116 60 28 20 124 12 4 36 79 80 109 69 53 101 45 60 93 118 62 30 22 126 14 6 38 83 84 111 71 55 103 47 62 95 120 64 32 24 128 16 8 40 87 88 112 72 56 104 48 64 96 119 63 31 23 127 15 7 39 85 86 110 70 54 102 46 63 94 117 61 29 21 125 13 5 37 81 82 108 68 52 100 44 61 92 115 59 27 19 123 11 3 35 77 78 106 66 113 57 50 98 42 59 90 h25 32 41 72 89 104H 1 24H2 H 73 74 H 75 76 H 77 78 H 79 80 H 81 82 H 83 84 H 85 86 H 87 88 t25 26 27 28 29 30 31 32 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 m1 s1 NKey WHRODDIHRRDWEW VTHZAVIASA N N N Y what is this verify The most common side effects include cough airway problems due to the anaesthesia wearing off reduced blood pressure and other complications such as changes in heart rate 6 Sugammadex is available as a generic medication 9 Contents 1 Medical uses 2 Pharmacology 2 1 Pharmacodynamics 3 Efficacy 4 Tolerability 5 History 6 ReferencesMedical uses editSugammadex is indicated for the reversal of neuromuscular blockade induced by rocuronium or vecuronium 5 6 Pharmacology editPharmacodynamics editSugammadex is a modified g cyclodextrin with a lipophilic core and a hydrophilic periphery This gamma cyclodextrin has been modified from its natural state by placing eight carboxyl thio ether groups at the sixth carbon positions These extensions extend the cavity size allowing greater encapsulation of the rocuronium molecule These negatively charged extensions electrostatically bind to the quaternary nitrogen of the target as well as contribute to the aqueous nature of the cyclodextrin Sugammadex s binding encapsulation of rocuronium is one of the strongest among cyclodextrins and their guest molecules The rocuronium molecule a modified steroid bound within sugammadex s lipophilic core is rendered unavailable to bind to the acetylcholine receptor at the neuromuscular junction nbsp nbsp Left Schematic of a sugammadex molecule encapsulating a rocuronium molecule Right Space filling model of a sugammadex sodium molecule in the same orientation Sugammadex unlike neostigmine does not inhibit acetylcholinesterase so cholinergic effects are not produced and co administration of an antimuscarinic agent glycopyrronium bromide or atropine is not needed Sugammadex might therefore be expected to have fewer adverse effects than the traditional reversal agents When muscle relaxant with rapid onset and short duration of action is required there has been little choice apart from succinylcholine but this drug has important contraindications for example it can trigger malignant hyperthermia in susceptible individuals it has a prolonged duration of action in patients with pseudocholinesterase deficiency and it causes an increase in plasma potassium concentration which is dangerous in some circumstances Rocuronium has a comparably quick onset in high dose 0 6 mg kg 1 to 1 mg kg 1 and can be rapidly reversed with sugammadex 16 mg kg 1 so this drug combination offers an alternative to suxamethonium Recurarisation a phenomenon of recurrence of neuromuscular block may occur where the reversal agents wear off before a neuromuscular blocking drug is completely cleared This is very unusual with all but the longest acting neuromuscular blocking drugs such as gallamine pancuronium or tubocurarine It has been demonstrated to occur only rarely with sugammadex and only when insufficient doses were administered 10 The underlying mechanism is thought to be related to redistribution of relaxant after reversal It may occur for a limited range of sugammadex doses which are sufficient for complex formation with relaxant in the central compartment but insufficient for additional relaxant returning to central from peripheral compartments 11 Sugammadex has been shown to have affinity for two other aminosteroid neuromuscular blocking agents vecuronium and pancuronium Although sugammadex has a lower affinity for vecuronium than for rocuronium reversal of vecuronium is still effective because fewer vecuronium molecules are present in vivo for equivalent blockade vecuronium is approximately seven times more potent than rocuronium Sugammadex encapsulates with a 1 1 ratio and therefore will adequately reverse vecuronium as there are fewer molecules to bind compared to rocuronium 12 Shallow pancuronium blockade has been successfully reversed by sugammadex in phase III clinical trials 13 Efficacy editA study was carried out in Europe looking at its suitability in rapid sequence induction It found that sugammadex provides a rapid and dose dependent reversal of neuromuscular blockade induced by high dose rocuronium 14 A Cochrane review on sugammadex concluded that sugammadex was shown to be more effective than placebo no medication or neostigmine in reversing muscle relaxation caused by neuromuscular blockade during surgery and is relatively safe Serious complications occurred in less than 1 of the patients who received sugammadex The results of this review article especially the safety results need to be confirmed by future trials on larger patient populations 15 The 2017 Cochrane review concluded that sugammadex has a better safety profile than neostigmine with 40 fewer adverse events 16 Specifically the risks of postoperative residual paralysis bradycardia nausea and vomiting are reduced if sugammadex is used as a reversal agent The British Journal of Anaesthesia published an article in 2015 in which the incidence of residual neuromuscular blockade could be reduced to zero if sugammadex is used as the reversal agent and the correct dosage is selected with the use of neuromuscular monitoring 17 Also when the reversal times of each agent were compared Data indicate that sugammadex was 10 22 minutes 6 6 times faster than neostigmine 1 96 vs 12 87 minutes in reversing moderate induced paralysis Sugammadex was 45 78 minutes 16 8 times faster than neostigmine 2 9 vs 48 8 minutes in reversing deep induced paralysis 16 The time saved by rapid reversal and the reduction of postoperative residual paralysis may reduce the overall hospital costs and provide significant improvements in patient safety citation needed Tolerability editSugammadex was generally well tolerated in clinical trials in surgical patients or healthy volunteers In pooled analyses the tolerability profile of sugammadex was generally similar to that of placebo or neostigmine plus glycopyrrolate 18 Sugammadex may theoretically interfere with hormonal contraceptives due to evidence from in vitro binding studies which showed it may bind to progestogen 5 History editSugammadex was discovered by the pharmaceutical company Organon at the Newhouse Research Site in Scotland 19 Organon was acquired by Schering Plough in 2007 Schering Plough merged with Merck in 2009 Sugammadex is now owned and sold by Merck The US Food and Drug Administration FDA initially rejected Schering Plough s New Drug Application for sugammadex in 2008 20 but finally approved the medication for use in the United States in December 2015 21 22 Sugammadex was approved for use in the European Union in July 2008 6 23 References edit SUGAMMADEX ACCORD Accord Healthcare Pty Ltd Archived 2022 10 12 at the Wayback Machine Department of Health and Aged Care Retrieved 30 March 2023 SUGAMMADEX SANDOZ Sandoz Pty Ltd Archived 2022 10 12 at the Wayback Machine Department of Health and Aged Care Retrieved 30 March 2023 Health Canada New Drug Authorizations 2016 Highlights Health Canada 14 March 2017 Retrieved 7 April 2024 Bridion 100 mg ml solution for injection Summary of Product Characteristics SmPC emc 18 March 2021 Archived from the original on 27 June 2021 Retrieved 27 June 2021 a b c d Bridion sugammadex injection solution DailyMed 14 December 2018 Archived from the original on 10 June 2020 Retrieved 10 June 2020 a b c d Bridion EPAR European Medicines Agency EMA 17 September 2018 Archived from the original on 10 June 2020 Retrieved 10 June 2020 Text was copied from this source which is c European Medicines Agency Reproduction is authorized provided the source is acknowledged Sugammadex Adroiq Union Register of medicinal products 30 May 2023 Retrieved 6 June 2023 Dosing for Bridion sugammadex www merckconnect com Archived from the original on 2019 01 12 Retrieved 2019 01 11 Sugammadex Adroiq European Medicines Agency 16 June 2023 Retrieved 19 June 2023 Miller RD March 2007 Sugammadex an opportunity to change the practice of anesthesiology Anesthesia and Analgesia 104 3 477 478 doi 10 1213 01 ane 0000255645 64583 e8 PMID 17312188 Eleveld DJ Kuizenga K Proost JH Wierda JM March 2007 A temporary decrease in twitch response during reversal of rocuronium induced muscle relaxation with a small dose of sugammadex Anesthesia and Analgesia 104 3 582 584 doi 10 1213 01 ane 0000250617 79166 7f PMID 17312212 S2CID 34811540 Welliver M October 2006 New drug sugammadex a selective relaxant binding agent AANA Journal 74 5 357 363 PMID 17048555 Decoopman M 2007 Reversal of pancuronium induced block by the selective relaxant binding agent sugammadex Eur J Anaesthesiol 24 Suppl 39 110 111 Puhringer FK Rex C Sielenkamper AW Claudius C Larsen PB Prins ME et al August 2008 Reversal of profound high dose rocuronium induced neuromuscular blockade by sugammadex at two different time points an international multicenter randomized dose finding safety assessor blinded phase II trial Anesthesiology 109 2 188 197 doi 10 1097 ALN 0b013e31817f5bc7 PMID 18648227 Abrishami A Ho J Wong J Yin L Chung F October 2009 Abrishami A ed Sugammadex a selective reversal medication for preventing postoperative residual neuromuscular blockade The Cochrane Database of Systematic Reviews 4 CD007362 doi 10 1002 14651858 CD007362 pub2 PMID 19821409 a b Hristovska AM Duch P Allingstrup M Afshari A August 2017 Efficacy and safety of sugammadex versus neostigmine in reversing neuromuscular blockade in adults The Cochrane Database of Systematic Reviews 8 8 CD012763 doi 10 1002 14651858 cd012763 PMC 6483345 PMID 28806470 Brueckmann B Sasaki N Grobara P Li MK Woo T de Bie J et al November 2015 Effects of sugammadex on incidence of postoperative residual neuromuscular blockade a randomized controlled study British Journal of Anaesthesia 115 5 743 751 doi 10 1093 bja aev104 PMID 25935840 Yang LP Keam SJ 2009 Sugammadex a review of its use in anaesthetic practice Drugs 69 7 919 942 doi 10 2165 00003495 200969070 00008 PMID 19441874 S2CID 195685307 Archived from the original on 2011 10 08 Retrieved 2010 03 29 Naguib M March 2007 Sugammadex another milestone in clinical neuromuscular pharmacology Anesthesia and Analgesia 104 3 575 581 doi 10 1213 01 ane 0000244594 63318 fc PMID 17312211 U S FDA Issues Action Letter for Sugammadex Press release Schering Plough 2008 08 01 Archived from the original on 2008 08 10 Retrieved 2008 08 02 Bridion sugammadex Injection U S Food and Drug Administration FDA 4 February 2016 Archived from the original on 10 June 2020 Retrieved 10 June 2020 FDA approves Bridion to reverse effects of neuromuscular blocking drugs used during surgery Press release Food and Drug Administration 2015 12 15 Archived from the original on 2015 12 15 Retrieved 2015 12 15 Bridion sugammadex Injection First and Only Selective Relaxant Binding Agent Approved in European Union Press release Schering Plough 2008 07 29 Archived from the original on 2008 09 24 Retrieved 2008 08 02 Portal nbsp Medicine Retrieved from https en wikipedia org w index php title Sugammadex amp oldid 1217670855, wikipedia, wiki, book, books, library,

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