Drug reference
Routine reversal of neuromuscular blockade induced by rocuronium or vecuronium ▶BY INTRAVENOUS INJECTION ▶Adult: Initially 2–4 mg/kg, then 4 mg/kg if required, administered if recurrence of neuromuscular blockade occurs; consult product literature for further details Immediate reversal of neuromuscular blockade induced by rocuronium ▶BY INTRAVENOUS INJECTION ▶Adult: 16 mg/kg (consult product literature)
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Cardiovascular disease (recovery may be delayed). elderly (recovery may be delayed). pre-existing coagulation disorders. recurrence of neuromuscular blockade— monitor respiratory function until fully recovered. use of anticoagulants (unrelated to surgery). wait 24 hours before re-administering rocuronium. wait 24 hours before re-administering vecuronium
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Scottish Medicines Consortium (SMC) decisions The Scottish Medicines Consortium, has advised (February 2013) that sugammadex (Bridion ®) is accepted for restricted use within NHS Scotland for the routine reversal of neuromuscular blockade in high-risk patients only, or where prompt reversal of neuromuscular block is required.
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Should only be administered by, or under the direct supervision of, personnel experienced in its use.
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→Appendix 1: sugammadex
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▶Common or very common Abdominal pain. arrhythmias. cough. dizziness. headache. nausea. procedural complications. skin reactions. taste altered. vomiting ▶Uncommon Hypersensitivity ▶Frequency not known Bronchospasm
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Use with caution—no information available.
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Avoid if eGFR less than 30 mL/minute/1.73 m2.
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There can be variation in the licensing of different medicines containing the same drug. Solution for injection ELECTROLYTES: May contain Sodium ▶Bridion (Merck Sharp & Dohme Ltd) Sugammadex (as Sugammadex sodium) 100 mg per 1 ml Bridion 500mg/5ml solution for injection vials | 10 vial P £1,491.00 (Hospital only) Bridion 200mg/2ml solution for injection vials | 10 vial P £596.40 (Hospital only) 1.3 Peri-operative analgesia Peri-operative analgesia Non-opioid analgesics Since non-steroidal anti-inflammatory drugs (NSAIDs) do not depress respiration, do not impair gastro-intestinal motility, and do not cause dependence, they may be useful alternatives or adjuncts to opioids for the relief of postoperative pain. NSAIDs may be inadequate for the relief of severe pain. Diclofenac sodium p. 1198, diclofenac potassium p. 1197, flurbiprofen p. 1203, ibuprofen p. 1203, ketoprofen p. 1207, paracetamol p. 465, parecoxib p. 1413, and ketorolac trometamol p. 1412 are licensed for postoperative use. Diclofenac and paracetamol can be given by injection as well as by mouth. Diclofenac sodium can be given by intravenous infusion for the treatment or prevention of postoperative pain. Intramuscular injections of diclofenac sodium and ketoprofen are rarely used; they are given deep into the gluteal muscle to minimise pain and tissue damage. Ketorolac trometamol is less irritant on intramuscular injection but pain has been reported; it can also be given by intravenous injection. Suppositories of diclofenac sodium and ketoprofen may be effective alternatives to the parenteral use of these drugs. Opioid analgesics Opioid analgesics are now rarely used as premedicants; they are more likely to be administered at induction. Pre- operative use of opioid analgesics is generally limited to those patients who require control of existing pain. See general notes on opioid analgesics and their use in postoperative pain. See the management of opioid-induced respiratory depression in Pre-medication and peri-operative drugs p. 1403. Intra-operative analgesia Opioid analgesics given in small doses before or with induction reduce the dose requirement of some drugs used during anaesthesia. Alfentanil p. 1413, fentanyl p. 479, and remifentanil p. 1414 are particularly useful because they act within 1–2 minutes and have short durations of action. The initial doses of alfentanil or fentanyl are followed either by successive intravenous injections or by an intravenous infusion; prolonged infusions increase the duration of effect. Repeated intra-operative doses of alfentanil or fentanyl should be given with care since the resulting respiratory depression can persist postoperatively and occasionally it may become apparent for the first time postoperatively when monitoring of the patient might be less intensive. Alfentanil, fentanyl, and remifentanil can cause muscle rigidity, particularly of the chest wall or jaw; this can be managed by the use of neuromuscular blocking drugs. In contrast to other opioids which are metabolised in the liver, remifentanil undergoes rapid metabolism by nonspecific blood and tissue esterases; its short duration of action allows prolonged administration at high dosage, without accumulation, and with little risk of residual postoperative respiratory depression. Remifentanil should not be given by intravenous injection intraoperatively, but it is well suited to continuous infusion; a supplementary analgesic is given before stopping the infusion of remifentanil. ANAESTHETICS, GENERAL › NMDA RECEPTOR ANTAGONISTS
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Initially 2–4 mg/kg, then 4 mg/kg if required,
First-line fragment. Read the complete Indications and Dose section above.
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16 mg/kg (consult product literature)
First-line fragment. Read the complete Indications and Dose section above.
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