Current evidence on the use of sugammadex for neuromuscular blockade antagonism during electroconvulsive therapy - a narrative review.

IF 4.2 4区 医学 Q1 ANESTHESIOLOGY
Vivek Arora, Laurence Henson, Sandeep Kataria
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Abstract

Depression is a common mental health problem that is associated with significant disability and mortality. Electroconvulsive therapy (ECT) has been demonstrated to be effective at resolving expression of suicidal intent in patients with depression. In less acute situations, patients are usually referred for ECT after several medication trials. Neuromuscular blocking agents (NMBAs) are used to block tonic-clonic motor activity and associated physical harm during the delivery of ECT. Succinylcholine (Sch), with its rapid onset of muscle relaxation, short self-terminating duration of action, and rapid subsequent return of spontaneous ventilation, is the NMBA of choice for ECT. However, the use of Sch is problematic or contraindicated is some situations. Although non-depolarizing NMBAs can be used, the variable time to onset of adequate muscle relaxation and prolonged duration of action have limited their widespread acceptance as alternatives to Sch. Recently, however, with the widespread availability of sugammadex, a chemically modified γ- cyclodextrin that rapidly and predictably reverses the effect of non-depolarizing NMBAs, the muscle relaxation achieved by rocuronium can predictably and effectively be reversed. In situations where Sch is contraindicated or otherwise problematic, rocuronium, followed by pharmacological antagonism with sugammadex, can provide a safe and effective muscle relaxation approach comparable to that of Sch in terms of duration of action. This review provides a summary of the current state of evidence for the use of sugammadex during ECT, which should lend support to further acceptance and future studies of sugammadex in the context of ECT.

在电休克治疗中使用苏加麦司拮抗神经肌肉阻滞的现有证据--叙述性综述。
抑郁症是一种常见的精神健康问题,与严重的残疾和死亡率有关。事实证明,电休克疗法(ECT)可有效缓解抑郁症患者的自杀倾向。在病情不太严重的情况下,患者通常会在经过数次药物治疗试验后转诊接受电休克疗法。神经肌肉阻断剂(NMBAs)用于阻断强直-阵挛运动活动,以及在实施 ECT 时造成的相关身体伤害。琥珀酰胆碱(Sch)具有肌肉松弛起效快、自我终止作用时间短、随后迅速恢复自主通气的特点,是 ECT 的首选 NMBA。然而,在某些情况下,使用 Sch 存在问题或禁忌。虽然可以使用非去极化 NMBA,但由于开始充分肌肉松弛的时间不定,且作用持续时间较长,限制了它们作为 Sch 的替代品被广泛接受。不过,最近随着苏甘麦得的广泛使用,罗库溴铵所实现的肌肉松弛可以预见并有效地逆转,苏甘麦得是一种经过化学修饰的γ-环糊精,可以快速且可预见地逆转非去极化 NMBAs 的效果。在施尔禁忌或存在其他问题的情况下,使用罗库溴铵,然后使用苏加麦司进行药理拮抗,可以提供一种安全有效的肌肉松弛方法,其作用持续时间可与施尔媲美。本综述总结了目前在电痉挛疗法中使用苏甘麦司的证据,这应有助于进一步接受苏甘麦司并在今后的电痉挛疗法研究中使用苏甘麦司。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
6.20
自引率
6.90%
发文量
84
审稿时长
16 weeks
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