2. Ingaruka za sodium ya sugammadex
Muri rusange, igipimo cya antagonistes ya muscarinike mugihe cyo gukanguka kwa anestheque biterwa nurwego rwo kuziba kwa neuromuscular. Kubwibyo, gukoresha monitor ya myoson byorohereza gushyira mu bikorwa mu buryo bwuzuye imitekerereze ya neuromuscular ikumira antagonist. Igenzura rya myorelaxation ritanga imbaraga z'amashanyarazi zagejejwe ku mitsi ya peripheri, bigatuma moteri isubiza (kwikuramo) imitsi ihuye. Imbaraga z'imitsi ziragabanuka cyangwa zikabura nyuma yo gukoresha myorelaxants. Nkigisubizo, urwego rwo guhagarika imitsi ya neuromuscular rushobora gutondekwa nku: guhagarika cyane [kutanyeganyega nyuma ya gari ya moshi enye-enye (TOF) cyangwa tonic stimulation], guhagarika cyane (nta gutitira nyuma ya TOF kandi byibura imwe ikurura nyuma ya tonic gukangura), hamwe no guhagarika (byibuze gukwega nyuma ya TOF).
Ukurikije ibisobanuro byavuzwe haruguru, igipimo gisabwa cyisukari ya sodium kugirango ihindure ikigereranyo giciriritse ni mg / kg 2, naho igipimo cya TOF gishobora kugera kuri 0.9 nyuma yiminota 2; igipimo gisabwa kugirango uhindure igihagararo cyimbitse ni 4 mg / kg, naho igipimo cya TOF gishobora kugera kuri 0.9 nyuma yiminota 1.6-3.3. Kugirango winjire vuba muri anesthesia, dose ya rocuronium bromide (1,2 mg / kg) ntabwo isabwa kugirango uhindurwe buri gihe cyane. Ariko, mugihe cyo gusubira byihutirwa guhumeka bisanzwe, subiza hamwe 16 mg / kg yaSodium ya Sugammadexni.
3. Gushyira Sodium ya Sugammadex mu barwayi badasanzwe
3.1. Mu barwayi b'abana
Imibare yo mu cyiciro cya II cy’ubuvuzi yerekana ko Sodium ya Sugammadex ikora neza kandi ifite umutekano mu baturage b’abana (harimo na neonates, impinja, abana n’ingimbi) nkuko biri mu bantu bakuze. Isesengura rya meta rishingiye ku bushakashatsi 10 (imanza 575) hamwe n’ubushakashatsi bwa retrospective cohort buherutse gusohoka (imanza 968) nabwo bwemeje ko igihe (median) cyo gukira igipimo cy’imitsi ya 4 ya myoclonic na 1 ya myoclonic ya 0.9 mu masomo hatanzwe rocuronium bromide 0,6 mg / kg na Sodammadex Sodium 2 mg / kg mu kwerekana T2 yari min 0,6 gusa mu bana (0,6 min) ugereranije n’abana (1.2 min) n'abantu bakuru (1.2 min). 1.2 min na kimwe cya kabiri cyabantu bakuru (1.2 min). Byongeye kandi, ubushakashatsi bumwe bwerekanye ko Sugammadex Sodium yagabanije indwara ya bradycardia ugereranije na neostigmine ifatanije na atropine. Itandukaniro muguhura nibindi bintu bibi nka bronchospasm cyangwa isesemi nyuma yo kubagwa no kuruka ntabwo byari bifite imibare. Byagaragaye kandi ko gukoresha Sodium Sugammadex bigabanya umubare w’imyivumbagatanyo nyuma yo kubagwa ku barwayi b’abana, ibyo bikaba byafasha mu micungire y’igihe cyo gukira. Mubyongeyeho, Tadokoro n'abandi. yerekanye mu bushakashatsi bwakozwe-kugenzura ko nta sano riri hagati ya allergique ya perioperative yatewe na anesthesia rusange y’abana no gukoresha sodium sugammadex. Kubwibyo, ikoreshwa rya Sugammadex Sodium ifite umutekano kubarwayi babana bato mugihe cyo gukanguka kwa anesteziya.
3.2. Gusaba abarwayi bageze mu zabukuru
Muri rusange, abarwayi bakuze bakunze kwibasirwa n'ingaruka zo kuziba kwa neuromuscula zisigaye kurusha abarwayi bakiri bato, kandi gukira bidatinze biturutse ku kuziba kwa neuromuscular biratinda. Mu cyiciro cya gatatu cy’ubushakashatsi ku mavuriro y’umutekano, imikorere, na farumasi ya Sugammadex ya Sodium ku barwayi bageze mu zabukuru, basanze Sugammadex Sodium yahinduye rocuronium kugira ngo habeho kwiyongera gake mu gihe cyo kuziba kwa neuromuscula ugereranije n’abarwayi bari munsi y’imyaka 65 (bivuze ibihe ya 2.9 min na 2.3 min). Nyamara, ubushakashatsi bwinshi bwerekanye ko sugammadex yihanganira abarwayi bageze mu zabukuru kandi ko nta burozi bwongeye kubaho. Kubwibyo, bifatwa ko Sugammadex Sodium ishobora gukoreshwa neza kubarwayi bageze mu zabukuru mugihe cyo gukanguka kwa anesteziya.
3.3. Koresha mu bagore batwite
Hano hari amabwiriza make yubuvuzi ku ikoreshwa rya Sugammadex Sodium ku bagore batwite, babyara kandi bonsa. Nyamara, ubushakashatsi bw’inyamaswa bwasanze nta ngaruka bugira ku ntera ya progesterone mu gihe cyo gutwita kandi nta kubyara cyangwa gukuramo inda ku mbeba zose, ibyo bikaba byayobora ikoreshwa rya Sodammadex Sodium mu gihe cyo gutwita, cyane cyane mu gihembwe cya mbere. Habayeho kandi ibibazo byinshi byo gukoresha ababyeyi isukari ya sodiumi munsi ya anesthesia rusange kubice bya cesarien, kandi nta kibazo cy’ababyeyi cyangwa uruhinja cyigeze kigaragara. Nubwo ubushakashatsi bumwe bwerekanye ko ugereranije no guhinduranya isukari ya sodium, haracyabura amakuru yizewe. Ikigaragara ni uko abagore batwite bafite hypertension gesta bakunze kuvurwa na magnesium sulfate. Kubuza kurekura acetylcholine binyuze muri ioni ya magnesium bibangamira ihererekanyabubasha ryamakuru ya neuromuscular, ryorohereza imitsi ya skeletale, kandi ryorohereza imitsi. Kubwibyo, magnesium sulfate irashobora kongera ingaruka zo guhagarika imitsi ya myorelaxants.
3.4. Gusaba abarwayi bafite impyiko idahagije
Sugammadex Sodium na sucralose-rocuronium bromide isohoka nimpyiko nka prototypes, kugirango metabolisme ihambiriye kimwe na Sodium Sugammadex idahuza igihe kirekire kubarwayi bafite ikibazo cyo kubura impyiko. Ariko, amakuru yubuvuzi yerekana koSodium ya SugammadexIrashobora gukoreshwa neza kubarwayi barwaye indwara zimpyiko zanyuma, kandi nta makuru yerekana ko gutinda kwa neuromuscular gutinda nyuma ya Sugammadex Sodium mubarwayi nkabo, ariko aya makuru agarukira kuri 48h nyuma yubuyobozi bwa Sugammadex. Byongeye kandi, sodium sugammadex-rocuronium bromide irashobora gukurwaho na hemodialysis hamwe na flux-filtration ya membrane. Ni ngombwa kumenya ko igihe cya rocuronium ihindagurika hamwe na sodium sugammadex ishobora kumara igihe kirekire ku barwayi barwaye impyiko. Kubwibyo gukoresha igenzura rya neuromuscular ni ngombwa.
4. Umwanzuro
Sugammadex Sodium ihindura byihuse guhagarika imitsi ya neuromuscular iterwa na myorelaxants ya aminosteroid igereranije kandi yimbitse, kandi igabanya cyane ibyago byo kuziba kwa neuromuscular bisigara ugereranije nibisanzwe byitwa acetylcholinesterase. Sodium sugammadex nayo yihutisha cyane igihe cyo kwiyongera mugihe cyo gukanguka, igabanya iminsi yo kuba mubitaro, yihutisha gukira kwabarwayi, igabanya amafaranga yibitaro, kandi ikiza umutungo wubuvuzi. Nyamara, reaction ya allergique hamwe na arththmias yumutima byagaragaye rimwe na rimwe mugihe cyo gukoresha Sodium ya Sugammadex, bityo rero biracyakenewe kuba maso mugihe cyo gukoresha Sodium Sugammadex no kureba ihinduka ryibimenyetso byubuzima bw’abarwayi, imiterere y’uruhu na ECG. Birasabwa gukurikirana igabanuka ryimitsi ya skeletale hamwe na monitor yo kuruhura imitsi kugirango tumenye neza ubujyakuzimu bwa neuromuscular no gukoresha igipimo cyiza cyasodium sugammadexkugirango turusheho kunoza ireme ryigihe cyo gukanguka.