Rocuronium-Sugammadex in Anesthesia for Electroconvulsive Therapy

Abstract

Electroconvulsive therapy (ECT) is a form of treatment which is very effective in many psychiatric disorders. The administration of anesthesia plays a positive role in the success of ECT and improves the oxygenation of the body during the process. Succinylcholine, is a depolarizing neuromuscular blocker of choice, the most common agent used to provide muscular relaxation during ECT. Alternative neuromusculer blokers have been used during anesthesia because of contraindications and serious side effects of succinylcholine. Rocuronium is a nondepolarizing neuromuscular blocker with intermediate time of action which may be used safely during ECT. Although relatively late onset of action and long half life compared to succinylcholine may seem as drawbacks, the new generation reversing agents like suggamadex have made these disadvantages ignorable. Sugammadex, a new generation neuromuscular blocker reversal agent, not having serious side effects as much as the classic reversals, such as cardiovascular side effects, is playing an important role in anesthesiology practice. In recent years, rocuronium - sugammadex combination is being included in the ECT practice extensively. In this paper, the usability of rocuronium-sugammadex combination as an alternative to succinylcholine has been revised.

Keywords

• -

Elektrokonvulsif Tedavi Anestezisinde Rokuronyum-Sugammadeks

Öz

Elektrokonvulsif tedavi (EKT), pek çok psikiyatrik bozuklukta etkili olan bir tedavi biçimidir. Anestezi uygulaması, hem EKT’nin başarılı olmasında rol oynar hem de işlem sırasında vücudun oksijen kullanımını iyileştirir. Süksinilkolin, EKT sırasında kas gevşekliği sağlamak için en sık kullanılan depolarizan özellikte nöromuskuler blokerdir. Süksinilkolinin ciddi yan etkilere sahip olması ve kontrendike olduğu durumlar sebebiyle, anestezi uygulaması için alternatif nöromuskuler blokerler kullanıma girmiştir. Rokuronyum, orta etki süreli nondepolarizan bir nöromuskuler bloker olup EKT sırasında güvenle kullanılmaktadır. Sugammadeks, bazı nondepolarizan nöromuskuler blokerlerin etkisinin sonlandırılması amacıyla kullanılan yeni nesil bir geri döndürücü ajandır. Geleneksel geri döndürücü ajanların meydana getirdiği kardiyovasküler yan etkiler gibi bir takım yan etkilerinin olmaması sebebiyle anestezi pratiğinde önemli bir yere sahip olmuştur. Rokronyum–sugammadeks  kombinasyonu gün geçtikçe daha fazla oranda EKT sırasında kullanılmaktadır. Bu derlemede, EKT anestezisinde süksinilkoline alternatif olarak rokuronyum–sugammadeks kombinasyonunun kullanılabilirliği gözden geçirilmiştir.

Anahtar Kelimeler

• EKT, nöromuskuler blokaj, sugammadeks

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