NMB Reversal Agents Flashcards
Neostigmine Class
Anticholinesterase
Neostigmine Use
Reversal of non-depolarizing neuromuscular blockade
Other: glaucoma, paralytic ileus, atonic bladder, myasthenia gravis
Neostigmine MOA
Acteylcholinesterase breaks down ACh - antagonizes to increase ACh @ synaptic cleft which deplaces NMB bound to nicotinic receptors
Neostigmine Dose
Dosing based on twitches on TOF
1 twitch = no reversal
2-3 twitches = 50 mcg/kg
4 twitches w/ fade = 40 mcg/kg
4 twitches w/o fade = 15-25 mcg/kg
Often administered with an antimuscarinic (glycopyrrolate)
5mg MAXNeostigmine Pharmacokinetics
Onset: 5 - 15 minutes
DOA: 45 - 90 minutes
Metabolism: pseudocholinesterases (50%)
Elimination: kidneys (50% unchanged)
Neostigmine Contraindications
Brady-arrhythmias & certain respiratory pathologies
Neostigmine Considerations
May cause bradycardia (r/f asystole) when paired with antimuscarinic
Side effects: salivation, bronchoconstriction, peristalsis, miosis, enhanced gastric secretions
Sugammadex Class
Selective relaxant binding agent
Sugammadex Use
reversal of steroidal NMBAs
Sugammadex MOA
Irreversibly encapsulates (binds to) steroidal NMBAs
Sugammadex Dose
Reversal of profound block: Post tetanic count <2: 16 mg/kg Post tetanic count >2: 4 mg/kg TOF 0: use post tetanic TOF 1: 4 mg/kg TOF 2+: 2 mg/kg
Sugammadex
Onset: 3 minutes
DOA: 15 min
Metabolism: NOT metabolized
Elimination: kidneys
Sugammadex Contraindications
ESRD
Anaphylaxis
Sugammadex Considerations
If paralysis desired after sugammadex administration, must use succinylcholine or a bezylisoquinolone (cis/atra)
Patients using hormonal contraceptives must use an additional, non-hormonal method of contraception for the next 7 days
