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Rapid sequence induction
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===== Reversal agents ===== * [[Sugammadex]] β It is used as a reversal agent for [[rocuronium]] and [[Vecuronium bromide|vecuronium]]. It works by encapsulating the paralytic drug thus preventing it from acting on the binding sites.<ref name=":11">{{Cite journal |last1=Schaller |first1=Stefan Josef |last2=Fink |first2=Heidrun |date=2013 |title=Sugammadex as a reversal agent for neuromuscular block: an evidence-based review |journal=Core Evidence |volume=8 |pages=57β67 |doi=10.2147/CE.S35675 |issn=1555-1741 |pmc=3789633 |pmid=24098155 |doi-access=free }}</ref> The dose of 16 mg/kg is used for immediate reversal after administration such as during RSI.<ref name=":11" /> Doses of 2 mg/kg and 4 mg/kg are used if the patient has twitches evident on a [[Neuromuscular monitoring|twitch monitor]] and terminates the rocuronium action within 3 minutes.<ref>{{Cite journal |last1=Otomo |first1=Shigeaki |last2=Iwasaki |first2=Hajime |last3=Takahoko |first3=Kenichi |last4=Onodera |first4=Yoshiko |last5=Sasakawa |first5=Tomoki |last6=Kunisawa |first6=Takayuki |last7=Iwasaki |first7=Hiroshi |date=2014 |title=Prediction of Optimal Reversal Dose of Sugammadex after Rocuronium Administration in Adult Surgical Patients |journal=Anesthesiology Research and Practice |volume=2014 |pages=848051 |doi=10.1155/2014/848051 |issn=1687-6962 |pmc=3942288 |pmid=24672542|doi-access=free }}</ref> The FDA initially did not approve Sugammadex due to concerns over potential allergic reactions, however it was subsequently approved on December 15, 2015, for use in the United States.<ref>{{Cite journal |last1=Cada |first1=Dennis J. |last2=Levien |first2=Terri L. |last3=Baker |first3=Danial E. |date=July 2016 |title=Sugammadex |journal=Hospital Pharmacy |volume=51 |issue=7 |pages=585β596 |doi=10.1310/hpj5107-585 |issn=0018-5787 |pmc=4981107 |pmid=27559192}}</ref> * [[Neostigmine]] β It can be used to reverse nondepolarizing neuromuscular blocking agents which cannot be reversed with Sugammadex, although its onset is much slower. It works by competitively inhibiting [[acetylcholinesterase]], an enzyme that breaks down acetylcholine.<ref name=":12">{{Cite journal |last1=Neely |first1=Grant A. |last2=Sabir |first2=Sarah |last3=Kohli |first3=Arpan |date=2022-08-15 |title=Neostigmine |publisher=StatPearls |pmid=29261883 |url=https://www.ncbi.nlm.nih.gov/books/NBK470596/#:~:text=Neostigmine%20is%20water-soluble,%20an,neuromuscular%20blocking%20agents%20after%20surgery. |language=en}}</ref> This results in an accumulation of acetylcholine present in the neuromuscular junction, effectively reversing the paralysis of the patient.<ref name=":12" /> The dosage is between 0.03 and 0.07 mg/kg. A common side effect of this drug is [[bradycardia]].<ref name=":12" /> Therefore, [[glycopyrrolate]], an [[anticholinergic]] drug, should be given immediately prior to neostigmine to prevent bradycardia.<ref name="Joanna 2014"/>
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