Search Results

ensure the safest and most responsible care possible. 2 Office-based anesthesia providers must be aware of the latest developments in hospital-based anesthesia and determine if new drugs and modalities offer improvements to the uniquely challenging aspects of office-based dental anesthesia. Sugammadex, a new drug gaining popularity in hospital anesthesia, has great potential to influence the way office-based dental anesthesia is practiced. ABOUT SUGAMMADEX In December 2015, the US Food and Drug Administration (FDA) approved sugammadex

estimated that there is 1 case for every 6,500 administrations. 2 Rocuronium is thought to have the highest frequency of allergic reactions. 3 We report 2 cases of anaphylaxis/anaphylactic shock believed to be induced by rocuronium, in which anaphylactic symptoms disappeared following administration of sugammadex and for which remission was achieved without further complications. In preparing this report, written consent for this publication was obtained from the patient herself (case 1) and from the patient and her parents (case 2

Knowledge of reversal agents, or pharmacologic antagonists, is essential for all providers of sedation and general anesthesia. Reversal agents are defined as any drug used to counter the pharmacologic effects of another drug. 1 This article reviews common reversal agents used in contemporary sedation and anesthesia practice for dentistry, specifically flumazenil, naloxone, neostigmine, sugammadex, and phentolamine, and discusses their use in emergency management and routine practice. This article also reviews safety considerations and

was observed. Approximately 115 minutes after the suspected infiltration, spontaneous ventilations resumed and continued regularly with a tidal volume of approximately 450 mL and a respiratory rate of approximately 10 breaths/min. Roughly 140 minutes after the suspected infiltration, the TOF ratio was 1.0. Sevoflurane was discontinued at that time, and sugammadex (200 mg) was administered. The patient regained consciousness approximately 7 minutes later and was extubated without difficulty in the operating room. The patient’s respiratory status remained stable

the degree of residual muscle relaxation. No muscle contraction of the adductor pollicis occurred with either train-of-four (TOF) stimulation or double-burst stimulation. A posttetanic count (PTC) was then conducted, but no twitches were observed. The patient exhibited no signs suggestive of spontaneous breathing or body movement even under the 1% end-tidal sevoflurane concentration. After administration of sugammadex (200 mg; 3 mg/kg), the TOF ratio was 95%. The sevoflurane was discontinued after confirmation of recovery from the rocuronium, and the trachea was

1000 mg was administered intravenously prior to concluding the case to reduce pain postoperatively. At the end of the surgery, sugammadex 120 mg was administered intravenously to ensure complete reversal of the rocuronium-induced neuromuscular blockade. The patient quickly emerged from general anesthesia with PSI values > 90 within 10 minutes following discontinuation of the maintenance agents. The total duration of general anesthesia was 89 minutes. Her recovery was uneventful with no symptoms of KLS postoperatively, and she was subsequently discharged on the fourth

the most common complaints associated with general dentistry, a numb lip and tongue long after the dental procedure is completed. It will be exciting to see if this drug will eventually be classified as one of those miracle breakthrough drugs that change clinical practice. Another wonder drug on the immediate horizon, ORG 25969 (sugammadex), is a new type of reversal agent for nondepolarizing neuromuscular blocking drugs (NMBs) such as rocuronium. Unlike anticholinesterase agents such as neostigmine that permit the concentration of acetylcholine to build up

reliable with moderate sedation techniques and the recovery profile were improved. Safety of intravenous dental sedation should improve, and patient satisfaction should increase. Another recently introduced drug in the United States that may have implications in office-based anesthesia is sugammadex (Bridion). Sugammadex reliably reverses neuromuscular blockade induced by rocuronium or vecuronium. It is a modified cyclodextrin with a lipophilic interior and hydrophilic exterior that encapsulates these steroidal neuromuscular blocking agents, rendering them