2. Ka pono o ka sodium sugarmadex
Ma keʻano laulā, ʻo ka nui o ka muscarinic antagonists i ka wā o ka hoʻāla ʻana i ka anesthetic e pili ana i ke kiʻekiʻe o ka neuromuscular blockade.No laila, ʻo ka hoʻohana ʻana i kahi monitor myoson e hoʻomaʻamaʻa i ka hoʻohana pono ʻana o ka neuromuscular blocking antagonists.Hāʻawi ka myorelaxation monitor i ka hoʻoulu ʻana i ka uila i hāʻawi ʻia i nā aʻalolo peripheral, e hana ana i ka pane kaʻa (twitching) i ka ʻiʻo pili.Hoʻemi a nalowale ka ikaika o ka ʻiʻo ma hope o ka hoʻohana ʻana i nā myorelaxants.ʻO ka hopena, hiki ke helu ʻia ke kiʻekiʻe o ka neuromuscular blockade e like me: poloka hohonu loa [ʻaʻohe ʻāwīwī ma hope o ʻehā mau kaʻaahi-o-ʻehā (TOF) a i ʻole ka hoʻoulu ʻana i ka tonic], poloka hohonu (ʻaʻohe ʻuʻu ma hope o TOF a ma kahi liʻiliʻi hoʻokahi ʻūlū ma hope o ka tonic. ka hoʻoulu ʻana), a me ka poloka haʻahaʻa (ma ka liʻiliʻi o hoʻokahi wili ma hope o TOF).
Ma muli o nā wehewehe i luna, ʻo ka nui o ka sodium sugars e hoʻohuli i ka poloka haʻahaʻa he 2 mg / kg, a hiki i ka ratio TOF ke hiki i ka 0.9 ma hope o 2 min;ʻO ka mea i manaʻo ʻia e hoʻohuli i ka poloka hohonu he 4 mg / kg, a hiki i ka ratio TOF ke hiki i 0.9 ma hope o 1.6-3.3 min.No ka hoʻokomo wikiwiki ʻana o ka anesthesia, ʻaʻole ʻōlelo ʻia ka rocuronium bromide kiʻekiʻe (1.2 mg/kg) no ka hoʻohuli maʻamau o ka poloka hohonu loa.Eia naʻe, i ka hihia o ka hoʻihoʻi ulia pōpilikia i ka ea kūlohelohe, hoʻihoʻi me 16 mg/kg oSugammadex Sodiumpaipai ʻia.
3. Hoʻohana i ka Sugammadex Sodium i nā maʻi kūikawā
3.1.I nā maʻi pediatric
Hōʻike ka ʻikepili mai nā haʻawina lapaʻau o ka pae II he ʻoi aku ka maikaʻi o ka Sugammadex Sodium i ka heluna pediatric (me nā neonates, nā pēpē, nā keiki a me nā ʻōpio) e like me ka heluna kanaka makua.ʻO kahi meta-analysis e pili ana i nā haʻawina 10 (575 mau hihia) a me kahi noiʻi cohort retrospective i hoʻopuka hou ʻia (968 mau hihia) ua hōʻoia pū ʻia ka manawa (median) no ka hoʻihoʻi ʻana i ka ratio o ka 4th myoclonic twitch i ka 1st myoclonic twitch i 0.9 i nā kumuhana hāʻawi ʻia ka rocuronium bromide 0.6 mg / kg a me Sugammadex Sodium 2 mg / kg ma ka hōʻike T2 he 0.6 min wale nō i nā pēpē (0.6 min) i hoʻohālikelike ʻia i nā keiki (1.2 min) a me nā pākeke (1.2 min).1.2 min a me ka hapalua o kēlā o nā mākua (1.2 min).Eia kekahi, ua ʻike ʻia kahi noiʻi ʻo Sugammadex Sodium i hōʻemi i ka ulu ʻana o bradycardia i hoʻohālikelike ʻia me ka neostigmine i hui pū ʻia me ka atropine.ʻO ka ʻokoʻa o ka loaʻa ʻana o nā hanana ʻino ʻē aʻe e like me ka bronchospasm a i ʻole ka nausea postoperative a me ka luaʻi ʻaʻole i koʻikoʻi nui.Ua hōʻike ʻia hoʻi ʻo ka hoʻohana ʻana i ka Sugammadex Sodium e hōʻemi i ka hopena o ka hoʻonāukiuki postoperative i nā maʻi pediatric, hiki ke kōkua i ka mālama ʻana i ka wā hoʻihoʻi.Eia kekahi, ʻo Tadokoro et al.Ua hōʻike ʻia i loko o kahi noiʻi hoʻokele hihia ʻaʻohe pilina ma waena o nā hopena maʻi perioperative i ka maʻi maʻi maʻi āpau a me ka hoʻohana ʻana i ka sodium sugammadex.No laila, palekana ka noi ʻana o Sugammadex Sodium i nā mea maʻi pediatric i ka wā ala o ka anesthesia.
3.2.Hoʻohana i nā poʻe maʻi kahiko
Ma keʻano laulā, ʻoi aku ka maʻalahi o nā poʻe maʻi kahiko i nā hopena o ke koena neuromuscular blockade ma mua o nā maʻi ʻōpio, a ʻoi aku ka lohi o ka hoʻihoʻi ʻana mai ka neuromuscular blockade.Ma kahi noiʻi lapaʻau multicenter phase III o ka palekana, ka maikaʻi, a me nā pharmacokinetics o Sugammadex Sodium i nā poʻe maʻi ʻelemakule, ua ʻike lākou ua hoʻohuli ʻo Sugammadex Sodium i ka rocuronium e hoʻonui iki i ka lōʻihi o ka neuromuscular blockade i hoʻohālikelike ʻia me nā mea maʻi ma lalo o 65 mau makahiki. o 2.9 min a me 2.3 min, pakahi).Eia nō naʻe, ua hōʻike ʻia kekahi mau haʻawina e ʻae maikaʻi ʻia ka sugammadex e nā poʻe maʻi ʻelemakule a ʻaʻole hiki ke hōʻeha hou i ka pua.No laila, manaʻo ʻia hiki ke hoʻohana palekana ʻia ka Sugammadex Sodium i nā poʻe maʻi maʻi i ka wā ala o ka anesthesia.
3.3.Hoʻohana i nā wahine hāpai
He liʻiliʻi nā alakaʻi lapaʻau e pili ana i ka hoʻohana ʻana i ka Sugammadex Sodium i nā wahine hāpai, momona a me ka lactating.Eia nō naʻe, ʻaʻohe hopena o nā haʻawina holoholona i nā pae progesterone i ka wā hāpai a ʻaʻohe hānau keiki a i ʻole ka hoʻopaʻa ʻana i nā ʻiole a pau, e alakaʻi ana i ka hoʻohana ʻana i ka Sugammadex Sodium i ka wā hāpai, ʻoi aku hoʻi i ka trimester mua.Aia kekahi mau hihia o ka hoʻohana ʻana i nā kōpaʻa sodium ma lalo o ka anesthesia maʻamau no nā ʻāpana cesarean, a ʻaʻohe pilikia o ka makuahine a i ʻole ka fetal i hōʻike ʻia.ʻOiai ua hōʻike kekahi mau haʻawina i kahi hoʻololi liʻiliʻi liʻiliʻi o ka hoʻololi ʻana o ka sodium sugars, aia nō ka nele o ka ʻikepili hilinaʻi.ʻO ka mea nui, mālama pinepine ʻia nā wahine hāpai me ka hypertension gestational me ka magnesium sulfate.Hoʻopilikia ka hoʻokuʻu ʻana o ka acetylcholine ma o nā ion magnesium i ka transduction ʻike neuromuscular junction, hoʻomaha i ka ʻiʻo iwi, a hoʻomaha i ka spasm muscle.No laila, hiki i ka magnesium sulfate ke hoʻonui i ka hopena neuromuscular blocking o myorelaxants.
3.4.Hoʻohana i nā mea maʻi me ka lawa ʻole o ka renal
Hoʻokuʻu ʻia ʻo Sugammadex Sodium a me sucralose-rocuronium bromide complexes e nā puʻupaʻa ma ke ʻano he prototypes, i mea e hoʻolōʻihi ʻia ai ka metabolism o Sugammadex Sodium i hoʻopaʻa ʻole ʻia i nā mea maʻi me ka lawa ʻole o ka renal.Eia naʻe, hōʻike ka ʻikepili lapaʻau i kēlāSugammadex Sodiumhiki ke hoʻohana palekana i nā mea maʻi me ka maʻi renal hope, a ʻaʻohe hōʻike o ka lohi neuromuscular blockade ma hope o ka Sugammadex Sodium i kēlā mau maʻi, akā ua kaupalena ʻia kēia mau ʻikepili i 48h ma hope o ka hoʻokele ʻana o Sugammadex Sodium.Eia kekahi, hiki ke hoʻopau ʻia ka paʻakikī sodium sugammadex-rocuronium bromide e ka hemodialysis me nā membrane filtration kiʻekiʻe.He mea nui e hoʻomaopopo i ka lōʻihi o ka hoʻohuli ʻana o rocuronium me ka sodium sugammadex hiki ke hoʻolōʻihi ʻia i nā maʻi me ka maʻi renal.No laila, pono ka hoʻohana ʻana i ka nānā ʻana i ka neuromuscular.
4. Ka hopena
Hoʻololi koke ʻo Sugammadex Sodium i ka blockade neuromuscular i hoʻokumu ʻia e nā myorelaxants aminosteroid haʻahaʻa a hohonu, a hoʻemi nui ia i ka hopena o ke koena neuromuscular blockade i hoʻohālikelike ʻia me nā mea hoʻopaneʻe acetylcholinesterase maʻamau.Hoʻonui nui ka sodium sugammadex i ka manawa o ka extubation i ka wā ala, hoʻopōkole i ka helu o nā lā o ka hale maʻi, hoʻolalelale i ka hoʻihoʻi ʻana o nā maʻi, hoʻemi i nā kumukūʻai halemai, a mālama i nā kumuwaiwai olakino.Eia nō naʻe, ua hōʻike ʻia nā hopena allergy a me nā arrhythmias cardiac i kekahi manawa i ka wā o ka hoʻohana ʻana i ka Sugammadex Sodium, no laila pono e makaʻala i ka wā e hoʻohana ai i ka Sugamadex Sodium a e nānā i nā loli o nā hōʻailona koʻikoʻi o nā maʻi, nā kūlana ʻili a me ECG.Manaʻo ʻia e nānā i ka hoʻopaʻa ʻana o ka ʻiʻo ʻiʻo me ka nānā ʻana i ka hoʻomaha hoʻomaha no ka hoʻoholo pono ʻana i ka hohonu o ka neuromuscular blockade a hoʻohana i ka nui kūpono osodium sugarmadexe hoʻomaikaʻi hou i ka maikaʻi o ka wā ala.