Use of Sugammadex in "Cannot Intubate, Cannot Ventilate" Scenarios: A Systematic Review of Case Reports.

IF 4.6 2区 医学 Q1 ANESTHESIOLOGY
Nancy G Abou Nafeh, Marie T Aouad, Amro F Khalili, Fatima G Serhan, Anthony M Sokhn, Roland N Kaddoum
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引用次数: 0

Abstract

After an induction dose of rocuronium, sugammadex in a dose of 16 mg.kg-1 has been shown to provide early reversal of the neuromuscular blockade. However, the use of sugammadex to rescue a "cannot intubate, cannot ventilate" (CICV) scenario remains controversial. The aim of this systematic review was to discuss case reports describing the use of sugammadex as a rescue reversal in CICV scenarios and analyze the influencing factors potentially shaping the outcome of such reversal. The study has been registered on International Prospective Register of Systematic Reviews (PROSPERO) (CRD42024514255). We conducted a systematic review of the literature using PubMed, Medline, and Embase. Records were included if they were case reports or case series published in peer-reviewed journals, describing the administration of sugammadex as a rescue reversal in CICV scenarios, and including clinical outcomes and details of the management. Sources were last searched on November 30, 2023. The articles selected were initially screened based on their titles and abstracts, and then complete articles were examined to determine their eligibility and compliance with the inclusion criteria. Two independent authors evaluated the quality of the individual studies using the Joanna Briggs Institute Critical Appraisal Checklist for Case Reports. Eight articles were included in our review. In all patients, CICV scenarios were declared minutes following induction. In 6/8 cases (75%), adequate spontaneous ventilation was restored after the administration of sugammadex. In the remaining 2 cases, sugammadex administration resulted in an obstructed pattern of breathing, and surgical airway was the successful rescue technique. There was wide variability in the sugammadex dose with a median (range) of 14 (5-16) mg.kg-1 and median timing (range) from rocuronium administration of 6 (2-10) minutes. This case-report-based review is susceptible to reporting bias and may not encompass all pertinent data and adverse events. Also, cases with both favorable and unfavorable outcomes may have not been published, and the heterogeneity of cases limits the ability to draw definitive conclusions. In summary, although these case reports suggest that sugammadex might be helpful in CICV scenarios, further research is needed to confirm its effectiveness. However, due to the rare occurrence of CICV events, gathering sufficient data for conclusive evidence may be challenging.

在 "无法插管、无法通气 "的情况下使用舒格迈司:病例报告的系统回顾。
在使用罗库溴铵诱导剂量后,剂量为 16 毫克/千克的舒马定已被证明可及早逆转神经肌肉阻滞。然而,在 "无法插管、无法通气"(CICV)的情况下使用苏加麦司进行抢救仍存在争议。本系统性综述旨在讨论描述在 CICV 情况下使用苏甘美作为抢救性逆转的病例报告,并分析可能影响此类逆转结果的影响因素。该研究已在国际前瞻性系统综述注册中心(PROSPERO)注册(CRD42024514255)。我们使用 PubMed、Medline 和 Embase 对文献进行了系统性回顾。只要是发表在同行评议期刊上的病例报告或系列病例,描述了在 CICV 情况下使用苏麦丁作为抢救性逆转的方法,并包括临床结果和管理细节,均被纳入。最后一次检索时间为 2023 年 11 月 30 日。所选文章首先根据标题和摘要进行筛选,然后对完整文章进行检查,以确定其是否符合纳入标准。两位独立作者使用乔安娜-布里格斯研究所(Joanna Briggs Institute)的病例报告批判性评估核对表(Critical Appraisal Checklist for Case Reports)对各项研究的质量进行了评估。八篇文章被纳入我们的综述。在所有患者中,CICV 情景都是在诱导后几分钟宣布的。在 6/8 例病例(75%)中,使用苏麦丁后恢复了充分的自主通气。在其余 2 个病例中,服用苏麦丁后出现呼吸受阻,手术通气是成功的抢救方法。苏甘麦司剂量的中位数(范围)为 14(5-16)毫克.千克-1,与罗库溴铵给药时间的中位数(范围)为 6(2-10)分钟。基于病例报告的综述容易出现报告偏差,可能无法涵盖所有相关数据和不良事件。此外,同时出现有利和不利结果的病例可能尚未发表,病例的异质性也限制了得出明确结论的能力。总之,尽管这些病例报告表明舒甘麦注射液可能有助于治疗 CICV,但仍需进一步研究以确认其有效性。然而,由于 CICV 事件很少发生,收集足够的数据以获得确凿证据可能具有挑战性。
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来源期刊
Anesthesia and analgesia
Anesthesia and analgesia 医学-麻醉学
CiteScore
9.90
自引率
7.00%
发文量
817
审稿时长
2 months
期刊介绍: Anesthesia & Analgesia exists for the benefit of patients under the care of health care professionals engaged in the disciplines broadly related to anesthesiology, perioperative medicine, critical care medicine, and pain medicine. The Journal furthers the care of these patients by reporting the fundamental advances in the science of these clinical disciplines and by documenting the clinical, laboratory, and administrative advances that guide therapy. Anesthesia & Analgesia seeks a balance between definitive clinical and management investigations and outstanding basic scientific reports. The Journal welcomes original manuscripts containing rigorous design and analysis, even if unusual in their approach.
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