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What is The reversal by sugammadex is possible with all the following neuromuscular blocker except- and explain in detail?
Reversal of Neuromuscular Block Several crude tests has been suggested to evaluate neuromuscular block 1. Head lift for 5 secs 2. Tongue protrusion 3. Hand grip 4. Ability to lift legs off bed 5. Hold jaw shut and prevent removal of tongue depressor.(most sensitive)(correlate TOF Ratio-> 0.9) For Recovery target TOF ratio > 0.9 Residual paralysis Can occur after general Anaesthesia C/F - Patient conscious , unable to breathe adequate tidal volume , motor weakness, desaturation M/n- suppo the ventilation Reversal agent Anticholinesterase Agent Neostigmine - it is reversible acetylcholinesterase inhibitor . This inhibition is present at all cholinergic synapses so has potent parasympathetic activity. Thus given accompanied with Atropine/ glycoprolate. Dose- 0.035- 0.05 mg/kg Peak effect- 1 to 2 min Suggamadex Direct reversal agent Gama- cyclodextrin compound Binds with aminosteroid in molar ratio 1:1 Acts best against Rocuronium and vecuronium. Sugammadex does not bind neuromuscular blocker which is devoid of steroid muscular. Thus it cannot reverse benzylisoquinoline.