神經肌肉阻斷劑的新解藥：Sugammadex

10.6666/ClinMed.202105_87(5).0052

吳襄齡

神經肌肉阻斷劑（neuromuscular blocking agent, NMBA） ； 拮抗劑（reversal agent） ； sugammadex ； neostigmine

臨床醫學月刊

87卷5期（2021 / 05 / 28）

306 - 309

繁體中文

Sugammadex問世至今已逾10年，已大幅影響許多麻醉醫師選擇神經肌肉阻斷劑的習慣和考量；有別於傳統拮抗神經肌肉阻斷劑的藥物，乙醯膽鹼酯酶抑制劑（acetylcholinesterase inhibitors），sugammadex具有專一、快速及可信賴的拮抗效果，即使病人處在深度的神經肌肉阻斷狀態，也可透過sugammadex被逆轉。只要依循在不同的神經阻斷狀態給予相對應的建議劑量，用藥後幾乎不會出現神經肌肉阻斷劑在體內殘留的情形。本篇文章將介紹sugammadex的作用機轉、適應症、不良反應等，並整理最新的研究報告讓臨床醫師們對這個藥物有更多認識。

1. Abdulatif, M,Lotfy, M,Mousa, M(2018).Sugammadex antagonism of rocuronium-induced neuromuscular blockade in patients with liver cirrhosis undergoing liver resection: a randomized controlled study.Minerva Anestesiol,84,929-937.
2. Adams, DR,Tollinche, LE,Yeoh, CB(2020).Short-term safety and effectiveness of sugammadex for surgical patients with end-stage renal disease: a two-centre retrospective study.Anaesthesia,75,348-352.
3. Butterly, A,Bittner, EA,George, E(2010).Postoperative residual curarization from intermediate-acting neuromuscular blocking agents delays recovery room discharge.Br J Anaesth,105,304-309.
4. Carron, M,Baratto, F,Zarantonello, F(2016).Sugammadex for reversal of neuromuscular blockade: a retrospective analysis of clinical outcomes and cost-effectiveness in a single center.Clinicoecon Outcomes Res,8,43-52.
5. de Souza, CM,Tardelli, MA,Tedesco, H(2015).Efficacy and safety of sugammadex in the reversal of deep neuromuscular blockade induced by rocuronium in patients with end-stage renal disease: A comparative prospective clinical trial.Eur J Anaesthesiol,32,681-686.
6. Ezri, T,Boaz, M,Sherman, A(2016).Sugammadex: an update.J Crit Care Med,2,16-21.
7. Fortier, LP,McKeen, D,Turner, K(2015).The RECITE study: a Canadian prospective, multicenter study of the incidence and severity of residual neuromuscular blockade.Anesth Analg,121,366-372.
8. Hopkins, PM,Cooke, PJ,Clarke, RC(2019).Consensus clinical scoring for suspected perioperative immediate hypersensitivity reactions.Br J Anaesth,123,e29-e37.
9. Hristovska, AM,Duch, P,Allingstrup, M(2017).Efficacy and safety of sugammadex versus neostigmine in reversing neuromuscular blockade in adults.Cochrane Database Syst Rev,8,CD012763.
10. Insinga, RP,Joyal, C,Goyette, A(2016).A discrete event simulation model of clinical and operating room efficiency outcomes of sugammadex versus neostigmine for neuromuscular block reversal in Canada.BMC Anesthesiol,16,114.
11. Kehlet, H(1997).Multimodal approach to control postoperative pathophysiology and rehabilitation.Br J Anaesth,78,606-617.
12. Murphy, GS,Szokol, JW,Marymont, JH(2008).Residual neuromuscular blockade and critical respiratory events in the postanesthesia care unit.Anesth Analg,107,130-137.
13. Nag, K,Singh, DR,Shetti, AN(2013).Sugammadex: a revolutionary drug in neuromuscular pharmacology.Anesth Essays Res,7,302-306.
14. Orihara, M,Takazawa, T,Horiuchi, T(2020).Comparison of incidence of anaphylaxis between sugammadex and neostigmine: a retrospective multicentre observational study.Br J Anaesth,124,154-163.
15. Park, ES,Lim, BG,Lee, WJ(2016).Sugammadex facilitates early recovery after surgery even in the absence of neuromuscular monitoring in patients undergoing laryngeal microsurgery: a single-center retrospective study.BMC Anesthesiol,16,48.
16. Partownavid, P,Romito, BT,Ching, W(2015).Sugammadex: a comprehensive review of the published human science, including renal studies.Am J Ther,22,298-317.
17. Rahe-Meyer, N,Fennema, H,Schulman, S(2014).Effect of reversal of neuromuscular blockade with sugammadex versus usual care on bleeding risk in a randomized study of surgical patients.Anesthesiology,121,969-977.
18. Richardson, MG,Raymond, BL(2019).Sugammadex administration in pregnant women and in women of reproductive potential: a narrative review.Anesth Analg,1
19. Won, YJ,Lim, BG,Lee, DK(2016).Sugammadex for reversal of rocuronium-induced neuromuscular blockade in pediatric patients: A systematic review and meta-analysis.Medicine,95,e4678.