Sugammadex Sodiumni igitabo gishya cyo kurwanya imitsi itorohereza imitsi (myorelaxants), cyatangajwe bwa mbere mu bantu mu 2005 kandi kuva icyo gihe cyakoreshejwe mu mavuriro i Burayi, Amerika n'Ubuyapani.Ugereranije n’imiti gakondo ya anticholinesterase, irashobora kurwanya imitsi yimbitse itagize ingaruka ku rwego rwa hydrolyzed acetylcholine kuri synapses ya cholinergique, ikirinda ingaruka mbi ziterwa na reseptor ya M na N, kandi ikazamura cyane ireme ryibyuka nyuma ya anesteziya.Ibikurikira nisubiramo ryubuvuzi bwa vuba bwisukari ya sodiumi mugihe cya anesthesia.
1. Incamake
Sugammadex Sodium ni yahinduwe γ-cyclodextrin ikomoka cyane cyane ihindura ingaruka zo guhagarika imitsi ya neuromuscular ikumira, cyane cyane rocuronium bromide.Sugammadex Sodium ikonjesha imitsi ya neuromuscular yubusa nyuma yo guterwa kandi igakora imitsi ya neuromuscular ikora uruganda ruhamye rwamazi binyuze mumyanya 1: 1.Mugihe cyo guhambira, hashyizweho intumbero yibintu byorohereza kugaruka kwa neuromuscular blocker kuva ihuriro rya neuromuscular ijya kuri plasma, bityo igahindura ingaruka zo guhagarika imitsi itanga, ikarekura reseptor ya nicotinic acetylcholine kandi ikagarura ubwandu bwa neuromuscular.
Muri steroidal neuromuscular blokers, Sodammadex Sodium ifite isano ikomeye kuri pecuronium bromide, ikurikirwa na rocuronium, hanyuma vecuronium na pancuronium.Birakwiye ko tumenya ko kugirango byihute kandi byihuse ingaruka zo guhagarika imitsi ya neuromuscular, birenze urugeroSugammadex Sodiumbigomba gukoreshwa ugereranije na myorelaxants mukuzenguruka.Byongeye kandi, Sodammadex Sodium ni antagonisti yihariye ya steroidal neuromuscular igabanya imiti, kandi ntishobora guhuza benzylisoquinoline idakwirakwiza myorelaxants kimwe na depolarizing myorelaxants, bityo rero, ntishobora guhindura ingaruka zo guhagarika imitsi ya neuromuscular.
2. Ingaruka ya sodium ya sugammadex
Muri rusange, igipimo cya antagonistes ya muscarinike mugihe cyo kubyuka kwa anestheque biterwa nurwego rwo guhagarika imitsi.Kubwibyo, gukoresha monitor ya myoson byoroshya gushyira mu bikorwa gushyira mu gaciro neuromuscular ikumira antagonist.Igenzura rya myorelaxation ritanga imbaraga z'amashanyarazi zishyikirizwa imitsi ya peripheri, bigatera moteri (kwikuramo) mumitsi ihuye.Imbaraga zimitsi zigabanuka cyangwa zikabura nyuma yo gukoresha myorelaxants.Nkigisubizo, urwego rwo guhagarika neuromuscular rushobora gutondekwa nku: guhagarika cyane [kutanyeganyega nyuma ya gari ya moshi enye-enye (TOF) cyangwa tonic stimulation], guhagarika byimbitse (nta gutereta nyuma ya TOF kandi byibura imwe ikurura nyuma ya tonic gukangura), hamwe no guhagarika (byibuze gukwega nyuma ya TOF).
Ukurikije ibisobanuro byavuzwe haruguru, ibipimo bisabwa bya sukari ya sodiumi kugirango uhindure buringaniye ni mg / kg 2, naho igipimo cya TOF gishobora kugera kuri 0.9 nyuma yiminota 2;igipimo gisabwa kugirango uhindure ibice byimbitse ni 4 mg / kg, naho igipimo cya TOF gishobora kugera kuri 0.9 nyuma ya 1.6-3.3 min.Kugirango winjire vuba anesteziya, dose ya rocuronium bromide (1,2 mg / kg) ntabwo isabwa kugirango uhindure ibintu byimbitse.Ariko, mugihe habaye gusubira byihutirwa guhumeka bisanzwe, guhindukira hamwe na 16 mg / kg yaSugammadex Sodiumni.
3. Gukoresha Sugammadex Sodium kubarwayi badasanzwe
3.1.Mu barwayi b'abana
Imibare yo mu cyiciro cya II cy’ubuvuzi yerekana ko Sugammadex Sodium ikora neza kandi ikagira umutekano mu baturage b’abana (harimo na neonates, impinja, abana ningimbi) nkuko biri mubantu bakuze.Isesengura rya meta rishingiye ku bushakashatsi 10 (imanza 575) hamwe n’ubushakashatsi bwakozwe na retrospective cohort (968) nabwo bwemeje ko igihe (median) cyo kugarura igipimo cy’imitsi ya 4 ya myoclonique kugeza kuri 1 ya myoclonique kuri 0.9 mu masomo. hatanzwe rocuronium bromide 0,6 mg / kg na Sugammadex Sodium 2 mg / kg kuri T2 yerekanaga 0,6 min gusa mubana (0,6 min) ugereranije nabana (1.2 min) nabakuze (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.Byerekanwe kandi ko gukoresha Sodiyumu ya Sugammadex bigabanya ibibazo byo guhagarika umutima nyuma y’abarwayi b’abana, bishobora gufasha mu micungire yigihe cyo gukira.Mubyongeyeho, Tadokoro n'abandi.yerekanye mubushakashatsi bwakozwe-kugenzura ko nta sano riri hagati ya allergique ya allergique itera anesthesia rusange yabana no gukoresha sodium sugammadex.Kubwibyo, gukoresha Sodammadex Sodium ifite umutekano mubarwayi babana mugihe cyo gukanguka kwa anesteziya.
3.2.Gusaba abarwayi bageze mu zabukuru
Muri rusange, abarwayi bakuze bakunze kwibasirwa ningaruka zo kuziba kwa neuromuscular zisigaye kurenza abarwayi bakiri bato, kandi gukira bidatinze kuva neuromuscular kuziba biratinda.Mu cyiciro cya gatatu cy’ubuvuzi bw’ubuvuzi ku bijyanye n’umutekano, efficacy, na pharmacokinetics ya Sugammadex Sodium ku barwayi bageze mu zabukuru, basanze Sodammadex Sodium yahinduye rocuronium kugira ngo habeho kwiyongera gake mu gihe cyo kuziba kwa neuromuscular ugereranije n’abarwayi bari munsi y’imyaka 65 (bivuze inshuro 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 Sodammadex Sodium ishobora gukoreshwa neza kubarwayi bageze mu zabukuru mugihe cyo kubyuka kwa anesteziya.
3.3.Koresha mu bagore batwite
Hano hari ubuyobozi buke mubuvuzi bwa Sugammadex Sodium kubagore batwite, babyara kandi bonsa.Nyamara, ubushakashatsi bwibikoko bwasanze nta ngaruka bigira kuri progesterone mugihe cyo gutwita kandi nta kubyara cyangwa gukuramo inda ku mbeba zose, ibyo bikaba byayobora ikoreshwa rya Sodammadex Sodium mugihe utwite, cyane cyane mugihembwe cya mbere.Habayeho kandi ibibazo byinshi byo gukoresha isukari ya sodium munsi ya anesthesia rusange kubice bya cesarienie, kandi nta kibazo cy’ababyeyi cyangwa inda cyigeze kigaragara.Nubwo ubushakashatsi bumwe bwerekanye ko habaho isukari ya sodium isukuye, haracyari kubura amakuru yizewe.Ikigaragara ni uko abagore batwite bafite hypertension gesta bakunze kuvurwa na magnesium sulfate.Kubuza kurekura acetylcholine binyuze muri ioni ya magnesium bibangamira ihererekanyamakuru ryamakuru ya neuromuscular, ryorohereza imitsi ya skeletale, kandi ryorohereza imitsi.Kubwibyo, magnesium sulfate irashobora kongera imbaraga zo guhagarika imitsi ya myorelaxants.
3.4.Gusaba abarwayi bafite ikibazo cyo kubura impyiko
Sugammadex Sodium na sucralose-rocuronium bromide isohoka nimpyiko nka prototypes, kuburyo metabolisme ihambiriye kimwe na Sugammadex Sodium idahuza igihe kirekire kubarwayi bafite ikibazo cyo kubura impyiko.Ariko, amakuru yubuvuzi yerekana koSugammadex SodiumIrashobora gukoreshwa neza kubarwayi barwaye impyiko 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 kuramba kubarwayi barwaye impyiko.Kubwibyo gukoresha ikoreshwa rya neuromuscular ni ngombwa.
4. Umwanzuro
Sugammadex Sodium ihindura byihuse inzitizi ya neuromuscular iterwa na myorelaxants ya aminosteroid iringaniye kandi yimbitse, kandi igabanya cyane kwandura ibisigisigi bya neuromuscular ugereranije nibisanzwe bya acetylcholinesterase.Sodium sugammadex nayo yihutisha cyane igihe cyo kwiyongera mugihe cyo gukanguka, igabanya iminsi yo gushyirwa mubitaro, yihutisha gukira kwabarwayi, igabanya amafaranga yibitaro, kandi ikiza umutungo wubuvuzi.Nyamara, allergie reaction hamwe na arththmias yumutima byavuzwe rimwe na rimwe mugihe cyo gukoresha Sodammadex Sodium, bityo rero biracyakenewe kuba maso mugihe cyo gukoresha Sodium Sugammadex no kureba ihinduka ryibimenyetso byabarwayi, ubuzima bwuruhu 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 kubyuka.
Igihe cyo kohereza: Nzeri-27-2021