Sugammadex for the reversal of muscle relaxation in general anaesthesia: A systematic review and economic assessment

Health Technology Assessment

Volumn 14, Issue 39, 2010, Pages 1-211

  Chambers, D ^a   Paulden, M ^a   Paton, F ^a   Heirs, M ^a   Duffy, S ^a   Craig, D ^a   Hunter, J ^b   Wilson, J ^c   Sculpher, M ^a   Woolacott, N ^a  

^a UNIVERSITY OF YORK   (United Kingdom)

^b UNIVERSITY OF LIVERPOOL   (United Kingdom)

^c York NHS Trust   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

ALFENTANIL; ANALGESIC AGENT; ANESTHETIC AGENT; ATRACURIUM; ATROPINE; CISATRACURIUM; FENTANYL; GLYCOPYRRONIUM BROMIDE; MIVACURIUM; MORPHINE; NEOSTIGMINE; NEUROMUSCULAR BLOCKING AGENT; OPIATE; PANCURONIUM; PLACEBO; PROPOFOL; REMIFENTANIL; ROCURONIUM; SEVOFLURANE; SUGAMMADEX; SUXAMETHONIUM; VECURONIUM;

AIRWAY CONSTRICTION; ANAPHYLAXIS; ANESTHETIC RECOVERY; ARTICLE; BRONCHOSPASM; CLINICAL ASSESSMENT; CLINICAL EFFECTIVENESS; CLINICAL PRACTICE; CLINICAL TRIAL; COST BENEFIT ANALYSIS; COST CONTROL; COST EFFECTIVENESS ANALYSIS; COUGHING; DRUG COST; DRUG HYPERSENSITIVITY; DRUG RESPONSE; DYSGEUSIA; DYSPNEA; ECONOMIC EVALUATION; EMERGENCY SURGERY; EVIDENCE BASED MEDICINE; FUNCTIONAL ASSESSMENT; GENERAL ANESTHESIA; HEALTH ECONOMICS; HEART ARREST; HEART ARRHYTHMIA; HUMAN; LOW DRUG DOSE; MALIGNANT HYPERTHERMIA; MORTALITY; MUSCLE FUNCTION; MUSCLE RELAXATION; MYALGIA; NAUSEA AND VOMITING; NEUROMUSCULAR BLOCKING; QT PROLONGATION; QUALITY OF LIFE; SIDE EFFECT; SINGLE DRUG DOSE; SYSTEMATIC REVIEW; UNITED KINGDOM; VOMITING; WHEEZING;

ANESTHESIA, GENERAL; ANESTHETICS, GENERAL; COST-BENEFIT ANALYSIS; GAMMA-CYCLODEXTRINS; GREAT BRITAIN; HUMANS; MUSCLE RELAXATION; NEUROMUSCULAR NONDEPOLARIZING AGENTS; RANDOMIZED CONTROLLED TRIALS AS TOPIC; STATE MEDICINE; TIME FACTORS;

EID: 77955979541     PISSN: 13665278     EISSN: None     Source Type: Journal    
DOI: 10.3310/hta14390     Document Type: Article

References (107)

1. Aitkenhead AR, Smith G, Rowbotham DJ, editors. Textbook of anaesthesia. 5th edn. Edinburgh: Churchill Livingstone, Elsevier; 2007.
2. Steele SM, Nielsen KC, Klein SM. Ambulatory anesthesia and perioperative analgesia. New York: McGraw-Hill Professional; 2005.
3. Fink H, Blobner M, Martyn JA. Neuromuscular blocking agents and reversal drugs. In Evers A, Maze M, editors. Anesthetic pharmacology: physiologic principles and clinical practice. Philadelphia, PA: Churchill Livingstone; 2004. pp. 573-97.
4. Combs JM, Combs GN. A literature review of the newest muscle relaxant: ORG 9426. CRNA 1994;5:104-12.
5. Dell DD, Kehoe C. Plasma cholinesterase deficiency. J Perianesth Nurs 1996;11:304-8.
6. Beaussier M, Boughaba MA. Residual neuromuscular blockade. Ann Fr Anesth Reanim 2005;24:1266-74.
7. Bevan DR, Donati F, Kopman AF. Reversal of neuromuscular blockade. Anesthesiology 1992;77:785-805.
8. Fuchs-Buder T, Claudius C, Skovgaard LT, Eriksson LI, Mirakhur RK, Viby-Mogensen J. Good clinical research practice in pharmacodynamic studies of neuromuscular blocking agents II: the Stockholm revision. Acta Anaesthesiol Scand 2007;51:789-808.
9. National Horizon Scanning Centre. Sugammadex (Org 25969) for reversal of muscle relaxation in general anaesthesia: horizon scanning technology briefing. Birmingham: National Horizon Scanning Centre (NHSC); 2006.
10. European Medicines Agency (EMEA). Assessment report for bridion. International nonproprietary name: sugammadex. Procedure no. EMEA/H/C/000885. London: EMEA; 2008.
11. Esmeron. In: Medicines compendium. 10th edn. Leatherhead: Datapharm Communications Ltd; 2008. pp. 926-8. URL: http://emc.medicines.org.uk/document.aspx?documentId=5166
12. Food and Drug Administration (FDA), Center for Drug Evaluation and Research, Division of Anesthesia Analgesia and Rheumatology Products. Briefing document for the Anesthesia and Life Support Drug Advisory Committee meeting. March 11, 2008. Bridion. NDA 22-225. Silver Spring, MD: Department of Health & Human Services, FDA, Center for Drug Evaluation & Research, Division of Anesthesia, Analgesia and Rheumatology Products; 2008.
13. Hemmerling TM, Le N. Brief review: neuromuscular monitoring: an update for the clinician. Can J Anaesth 2007;54:58-72.
14. Kopman AF, Zhaku B, Lai KS. The 'intubating dose' of succinylcholine: the effect of decreasing doses on recovery time. Anesthesiology 2003;99:1050-4.
15. Naguib M. Sugammadex: another milestone in clinical neuromuscular pharmacology. Anesth Analg 2007;104:575-81.
16. Sorgenfrei IF, Norrild K, Larsen PB, Stensballe J, Ostergaard D, Prins ME, et al. Reversal of rocuronium-induced neuromuscular block by the selective relaxant binding agent sugammadex: a dose-finding and safety study. Anesthesiology 2006;104:667-74.
17. Nicholson WT, Sprung J, Jankowski CJ. Sugammadex: a novel agent for the reversal of neuromuscular blockade. Pharmacotherapy 2007;27:1181-8.
18. Welliver M, McDonough J, Kalynych N, Redfern R. Discovery, development, and clinical application of sugammadex sodium, a selective relaxant binding agent. Drug Design Dev Ther 2008;2:49-59.
19. Lu G, Ades AE. Combination of direct and indirect evidence in mixed treatment comparisons. Stat Med 2004;23:3105-24.
20. Higgins JP, White IR, Anzures-Cabrera J. Metaanalysis of skewed data: combining results reported on log-transformed or raw scales. Stat Med 2008;27:6072-92.
21. Ali HH, Utting JE, Gray TC. Quantitative assessment of residual antidepolarizing block. II. Br J Anaesth 1971;43:478-85.
22. Ali HH, Utting JE, Gray TC. Quantitative assessment of residual antidepolarizing block. I. Br J Anaesth 1971;43:473-7.
23. Organon, Schering-Plough. FDA Anesthetic and Life Support Advisory Committee meeting. Sugammadex sodium injection (NDA 22-225). March 11, 2008. Briefing document (background package). Kenilworth, NJ: Organon USA, Schering-Plough Corporation; 2008.
24. Centre for Reviews and Dissemination (CRD). Systematic reviews: CRD's guidance for undertaking reviews in health care. York: University of York; 2009.
25. Caldwell DM, Ades AE, Higgins JPT. Simultaneous comparison of multiple treatments: combining direct and indirect evidence. BMJ 2005;331:897-900.
26. Organon. Comparison of sugammadex with neostigmine during laparoscopic cholecystectomy or appendectomy (Study 19.4.318AM2). In ClinicalTrials.gov (internet). Bethesda, MD: National Library of Medicine (US). 2008. Accessed 11 September 2008. URL: http://clinicaltrials.gov/show/NCT00724932NLMIdentifier:NCT00724932
27. Organon. Comparison of 4.0 mg/kg sugammadex at 1-2 PTC in renal or control patients (19.4.328). In ClinicalTrials.gov (internet). Bethesda, MD: National Library of Medicine (US). 2008. Accessed 11 September 2008. URL: http://clinicaltrials.gov/show/NCT00702715NLMIdentifier:NCT00702715
28. Organon. Comparison sugammadex administered at 1-2 PTCs or better with neostigmine administered as per standard of care to reverse rocuronium-induced neuromuscular blockade in adult subjects undergoing elective open abdominal procedure (19.4.334). In: ClinicalTrials.gov (internet). Bethesda, MD: National Library of Medicine (US). 2008. Accessed 11 September 2008. URL: http://clinicaltrials.gov/show/NCT00675792NLMIdentifier:NCT00675792
29. Flockton EA, Mastronardi P, Hunter JM, Gomar C, Mirakhur RK, Aguilera L, et al. Reversal of rocuronium-induced neuromuscular block with sugammadex is faster than reversal of cisatracurium-induced block with neostigmine. Br J Anaesth 2008;100:622-30.
30. Blobner M, Eriksson L, Scholz J, Hillebrand H, Pompei L. Sugammadex (2.0 mg/kg) significantly faster reverses shallow rocuronium-induced neuromuscular blockade compared with neostigmine (50 mcg/kg) [abstract]. Eur J Anaesthesiol 2007;24:125.
31. Organon. A bridging trial comparing Org 25969 at reappearance of T2 in Japanese and Caucasian subjects. Part A: Japanese subjects (19.4.208A). In ClinicalTrials. gov (internet). Bethesda, MD: National Library of Medicine (US). 2006. Accessed 11 September 2008. URL: http://clinicaltrials.gov/show/NCT00591409NLMIdentifier:NCT00591409
32. Sparr HJ, Vermeyen KM, Beaufort AM, Rietbergen H, Proost JH, Saldien V, et al. Early reversal of profound rocuronium-induced neuromuscular blockade by sugammadex in a randomized multicenter study: efficacy, safety, and pharmacokinetics. Anesthesiology 2007;106:935-43.
33. Groudine SB, Soto R, Lien C, Drover D, Roberts K. A randomized, dose-finding, phase II study of the selective relaxant binding drug, Sugammadex, capable of safely reversing profound rocuroniuminduced neuromuscular block. Anesth Analg 2007;104:555-62.
34. Puhringer FK, Rex C, Sielenkamper AW, Claudius C, Larsen PB, Prins ME, et al. Reversal of profound, high-dose rocuronium-induced neuromuscular blockade by sugammadex at two different time points: an international, multicenter, randomized, dose-finding, safety assessor-blinded, phase II trial. Anesthesiology 2008;109:188-97.
35. Duvaldestin P, Kuizenga K, Kjaer CC, Saldien V, Debaene B. Sugammadex achieves fast recovery from profound neuromuscular blockade induced by rocuronium or vecuronium: a dose-response study [abstract]. Eur J Anaesthesiol 2007;24:123.
36. Jones RK, Caldwell JE, Brull SJ, Soto R. Faster reversal of profound rocuronium-induced neuromuscular blockade with sugammadex vs neostigmine [abstract]. In American Society of Anesthesiologists. Annual meeting; 13-17 October 2007. San Francisco, CA. 2007. p. A1577.
37. Lemmens HJM, El-Orbany MI, Berry J, Martin G. Sugammadex reverses profound vecuronium blockade more rapidly than neostigmine abstract. In: American Society of Anesthesiologists. Annual meeting; 13-17 October 2007. San Francisco, CA; 2007. p. A1578.
38. Jones RK, Caldwell JE, Brull SJ, Soto RG. Reversal of profound rocuronium-induced blockade with sugammadex: a randomized comparison with neostigmine. Anesthesiology 2008;109:816-24.
39. Organon. A bridging trial comparing Org 25969 at 1-2 PTC in Japanese and Caucasian subjects. Part A: Japanese subjects (19.4.209A). In ClinicalTrials. gov (internet). Bethesda, MD: National Library of Medicine (US). 2005-2006. Accessed 30 May 2008. URL: http://clinicaltrials.gov/show/NCT00591786NLMIdentifier:NCT00591786
40. de Boer HD, Driessen JJ, Marcus MAE, Kerkkamp H, Heeringa M, Klimek M. Reversal of rocuronium-induced (1.2 mg/kg) profound neuromuscular block by sugammadex: amulticenter, dose-finding and safety study. Anesthesiology 2007;107:239-44.
41. Lee C, Jahr JS, Candiotti K, Warriner B, Zornow MH. Reversal of profound rocuronium NMB with sugammadex is faster than recovery from succinylcholine [abstract]. In: American Society of Anesthesiologists. Annual meeting; 13-17 October 2007. San Francisco, CA; 2007. p. A988.
42. Adamus M, Belohlavek R, Koutna J, Vujcikova M, Janaskova E. Cisatracurium vs. rocuronium: a prospective, comparative, randomized study in adult patients under total intravenous anaesthesia. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2006;150:333-8.
43. Bailey DM, Nicholas AD. Comparison of atracurium and vecuronium during anaesthesia for laparoscopy. Br J Anaesth 1988;61:557-9.
44. Barrio J, San Miguel G, Garcia V, Pelegrin F. [Influence of neostigmine on the course of neuromuscular blockade with rocuronium or cisatracurium: a randomized, double-blind trial.] Rev Esp Anestesiol Reanim 2007;54:399-404.
45. Berg H, Roed J, Viby-Mogensen J, Mortensen CR, Engbaek J, Skovgaard LT, et al. Residual neuromuscular block is a risk factor for postoperative pulmonary complications: a prospective, randomised, and blinded study of postoperative pulmonary complications after atracurium, vecuronium and pancuronium. Acta Anaesthesiol Scand 1997;41:1095-103.
46. Bevan JC, Collins L, Fowler C, Kahwaji R, Rosen HD, Smith MF, et al. Early and late reversal of rocuronium and vecuronium with neostigmine in adults and children. Anesth Analg 1999;89:333-9.
47. Carroll MT, Mirakhur RK, Lowry D, Glover P, Kerr CJ. A comparison of the neuromuscular blocking effects and reversibility of cisatracurium and atracurium. Anaesthesia 1998;53:744-8.
48. Della Rocca G, Pompei L, Coccia C, Costa MG, Cecchini V, Vilardi V, et al. Atracurium, cisatracurium, vecuronium and rocuronium in patients with renal failure. Minerva Anestesiol 2003;69:605-15.
49. Suy K, Morias K, Cammu G, Hans P, van Duijnhoven WGF, Heeringa M, et al. Effective reversal of moderate rocuronium- or vecuroniuminduced neuromuscular block with sugammadex, a selective relaxant binding agent. Anesthesiology 2007;106:283-8.
50. Puhringer F, Blaszyk M, Cammu G, Sparr H, Heeringa M. Sugammadex achieves fast recovery from shallow neuromuscular blockade induced by rocuronium or vecuronium: dose-response studies [abstract]. Eur J Anaesthesiol 2007;24:111.
51. Staals LM, Snoeck MM, Driessen JJ, Flockton EA, Heeringa M, Hunter JM. Multicentre, parallelgroup, comparative trial evaluating the efficacy and safety of sugammadex in patients with end-stage renal failure or normal renal function. Br J Anaesth 2008;101:492-7.
52. Plaud B, Meretoja O, Pohl B, Mirakhur RK, Raft J. Reversal of rocuronium-induced neuromuscular blockade with sugammadex in paediatric and adult patients [abstract]. Eur J Anaesthesiol 2007;24:124.
53. Amao R, Zornow MH, McTaggart Cowan R, Cheng DCH, Allard M. Sugammadex safely reverses rocuronium-induced blockade in patients with pulmonary disease [abstract]. In American Society of Anesthesiologists. Annual meeting; 13-17 October 2007. San Francisco, CA; 2007. p. A1582.
54. Dahl V, Pendeville PE, Hollman MW, Hier T, Blobner M. Reversal of rocuroniuminduced neuromuscular blockade by sugammadex in cardiac patients [abstract]. In American Society of Anesthesiologists. Annual meeting; 13-17 October 2007. San Francisco, CA; 2007. p. A1581.
55. McDonagh DL, Benedict PE, Kovac AL, Drover D, Brister NW. Efficacy and safety of sugammadex for reversal of rocuronium-induced blockade in elderly patients [abstract]. In American Society of Anesthesiologists. Annual meeting; 13-17 October 2007. San Francisco, CA; 2007. p. A1583.
56. Alvarez-Gomez JA, Wattwil M, Vanacker B, Lora-Tamayo JI, Khuenl- Brady KS. Reversal of vecuronium-induced shallow neuromuscular blockade is significantly faster with sugammadex compared with neostigmine [abstract]. Eur J Anaesthesiol 2007;24:124-5.
57. Schultz P, Ibsen M, Ostergaard D, Skovgaard LT. Onset and duration of rocuronium - from tracheal intubation, through intense block to complete recovery. Acta Anaesthesiol Scand 2001;45:612-7.
58. Lee C, Jahr JS, Candiotti KA, Warriner B, Zornow MH, Naguib M. Reversal of profound neuromuscular block by sugammadex administered three minutes after rocuronium: a comparison with spontaneous recovery from succinylcholine. Anesthesiology 2009;110:1020-5.
59. Staals LM, Snoek MMJ, Flockton E, Heeringa M, Driessen JJ. The efficacy of sugammadex in subjects with impaired renal function [abstract]. Eur J Anaesthesiol 2007;24:122-3.
60. Marti Masso JF, Liceaga Cundin G. Drugs affecting autonomic functions or the extrapyramidal system. Agents with cholinergic effects. In Dukes MNG, Aronson JK, editors. Meyler's side effects of drugs: an encyclopedia of adverse reactions and interactions. 14th edn. Amsterdam: Elsevier; 2000. pp. 434-40.
61. Schering-Plough Corporation. U.S. FDA issues action letter for sugammadex. Press release, 1 August 2008. URL: www.schering-plough.com/news/news_article.aspx?reqid=1182475
62. Light KP, Lovell AT, Butt H, Fauvel NJ, Holdcroft A. Adverse effects of neuromuscular blocking agents based on yellow card reporting in the U.K.: are there differences between males and females? Pharmacoepidemiol Drug Saf 2006;15:151-60.
63. Baillard C, Gehan G, Reboul-Marty J, Larmignat P, Samama CM, Cupa M. Residual curarization in the recovery room after vecuronium. Br J Anaesth 2000;84:394-5.
64. Bhananker SM, O'Donnell JT, Salemi JR, Bishop MJ. The risk of anaphylactic reactions to rocuronium in the United States is comparable to that of vecuronium: an analysis of food and drug administration reporting of adverse events. Anesth Analg 2005;101:819-22.
65. Cammu G, De Witte J, De Veylder J, Byttebier G, Vandeput D, Foubert L, et al. Postoperative residual paralysis in outpatients versus inpatients. Anesth Analg 2006;102:426-9.
66. Laake JH, Rottingen JA. Rocuronium and anaphylaxis: a statistical challenge. Acta Anaesthesiol Scand 2001;45:1196-203.
67. Laxenaire MC, Mertes PM, Groupe d'Etudes des Reactions Anaphylactoides P. Anaphylaxis during anaesthesia. Results of a two-year survey in France. Br J Anaesth 2001;87:549-58.
68. Malinovsky JM, Decagny S, Wessel F, Guilloux L, Mertes PM. Systematic follow-up increases incidence of anaphylaxis during adverse reactions in anesthetized patients. Acta Anaesthesiol Scand 2008;52:175-81.
69. Maybauer DM, Geldner G, Blobner M, Puhringer F, Hofmockel R, Rex C, et al. Incidence and duration of residual paralysis at the end of surgery after multiple administrations of cisatracurium and rocuronium. Anaesthesia 2007;62:12-17.
70. Mertes PM, Laxenaire M-C, Alla F, Groupe d'Etudes des Reactions Anaphylactoides Peranesthesiques. Anaphylactic and anaphylactoid reactions occurring during anesthesia in France in 1999-2000. Anesthesiology 2003;99:536-45.
71. Murphy GS, Szokol JW, Franklin M, Marymont JH, Avram MJ, Vender JS. Postanesthesia care unit recovery times and neuromuscular blocking drugs: a prospective study of orthopedic surgical patients randomized to receive pancuronium or rocuronium. Anesth Analg 2004;98:193-200.
72. Murphy GS, Szokol JW, Marymont JH, Greenberg SB, Avram MJ, Vender JS. Residual neuromuscular blockade and critical respiratory events in the postanesthesia care unit. Anesth Analg 2008;107:130-7.
73. Neal SM, Manthri PR, Gadiyar V, Wildsmith JA. Histaminoid reactions associated with rocuronium. Br J Anaesth 2000;84:108-11.
74. Dexter F, Gan TJ, Naguib M, Lubarsky DA. Cost identification analysis for succinylcholine. Anesth Analg 2001;92:693-9.
75. Rosenberg H, Davis M, James D, Pollock N, Stowell K. Malignant hyperthermia. Orphanet J Rare Dis 2007;2:21.
76. Schreiber J-U, Lysakowski C, Fuchs-Buder T, Tramer MR. Prevention of succinylcholine-induced fasciculation and myalgia: a meta-analysis of randomized trials. Anesthesiology 2005;103:877-84.
77. Cheng C-R, Sessler DI, Apfel CC. Does neostigmine administration produce a clinically important increase in postoperative nausea and vomiting? Anesth Analg 2005;101:1349-55.
78. Tramer MR, Fuchs-Buder T. Omitting antagonism of neuromuscular block: effect on postoperative nausea and vomiting and risk of residual paralysis. A systematic review. Br J Anaesth 1999;82:379-86.
79. Suresh D, Carter JA, Whitehead JP, Goldhill DR, Flynn PJ. Cardiovascular changes at antagonism of atracurium. Effects of different doses of premixed neostigmine and glycopyrronium in a ratio of 5:1. Anaesthesia 1991;46:877-80.
80. Abrishami A, Ho J, Wong J, Chung F. Selective reversal of rocuronium-induced neuromuscular block by sugammadex: a systematic review [abstract]. In American Society of Anesthesiologists. Annual meeting, 18-22 October 2008. Orlando, FL; 2008. p. A363.
81. Blobner M, Rietbergen H, Hermens Y, Mirakhur R. Recovery from shallow rocuroniuminduced neuromuscular blockade is consistently more rapid with sugammadex compared with neostigmine: results from a pooled analysis of phase II and III studies [abstract]. Eur J Anaesthesiol 2008;25:9AP3-2.
82. Khuenl-Brady K, Rietbergen H, Prins M, Mirakhur R. Reversal of shallow vecuroniuminduced neuromuscular blockade is achieved more rapidly with sugammadex than with neostigmine: a pooled analysis of phase II and III clinical trials [abstract]. Eur J Anaesthesiol 2008;25:9AP5-10.
83. Chiu JW, White PF. The pharmacoeconomics of neuromuscular blocking drugs. Anesth Analg 2000;90:S19-23.
84. Chow JL, Macario A, Marx SE. Cost-effectivenesss of cisatracurium in patients with acute respiratory distress syndrome (ARDS) modeled by Markov computer simulation. Crit Care Med 2003;31:A62-A62.
85. Loughlin KA, Weingarten CM, Nagelhout J, Stevenson JG. A pharmacoeconomic analysis of neuromuscular blocking agents in the operating room. Pharmacotherapy 1996;16:942-50.
86. Macario A, Marx SE, Chow JL. Is cisatracurium cost effective for neuromuscular blockade in the ICU? A Markov computer simulation study. Value Health 2003;6:373.
87. Ortega A, Sarobe C, Iribarren MJ, Giraldez J. Cost analysis of neuromuscular blocking agents in the operating room: cisatracurium, atracurium, vecuronium and rocuronium. Pharm World Sci 2000;22:82-7.
88. White PF. Pharmacoeconomic issues related to selection of neuromuscular blocking agents. Am J Health Syst Pharm 1999;56:S18-21.
89. ® (sugammadex). Dose and administration (internet). Accessed 10 February 2009. URL: www.bridion.com/HCP/About_Bridion/Dosage_and_Administration/index.asp.
90. Jones L, Hawkins N, Westwood M, Wright K, Richardson G, Riemsma R. Systematic review of the clinical effectiveness and cost-effectiveness of capecitabine (XelodaR) for locally advanced and/ or metastatic breast cancer. Health Technol Assess 2004;8(5).
91. Curtis L. Unit costs of health and social care 2008. Canterbury: Personal Social Services Research Unit, University of Kent; 2008.
92. Department of Health. NHS reference costs 2006-07 (Appendix NSRC1) (internet). Department of Health; 2008. Accessed 11 February 2009. URL: www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_082571.
93. Schwartz DE, Matthay MA, Cohen NH. Death and other complications of emergency airway management in critically ill adults. A prospective investigation of 297 tracheal intubations. Anesthesiology 1995;82:367-76.
94. Smith CE. Rapid-sequence intubation in adults: indications and concerns. Clinical Pulmonary Medicine 2001;8:147-65.
95. National Statistics. Mortality statistics. Deaths registered in 2006. Review of the Registrar General on deaths in England and Wales, 2006. Laid before Parliament pursuant to Section 19 Registration Service Act 1953. DR_06. 2008. URL: www.statistics.gov.uk/downloads/theme_health/DR-2006/DR_06Mort_Stats.pdf
96. Kind P, Hardman G, Macran S. UK population norms for EQ-5D. York: Centre for Health Economics, University of York; 1999.
97. National Institute for Health and Clinical Excellence (NICE). Guide to the methods of technology appraisal. London: NICE; 2008.
98. Abrishami A, Ho J, Wong J, Yin L, Chung F. Sugammadex, a selective reversal medication for preventing postoperative residual NMB. Cochrane Database Syst Rev 2009; Issue 4, Art. No: CD007362. DOI: 10.1002/14651858.CD007362.pub2.
99. Muendel K, Kaminski E, Pasternak R, Perov S. Recovery of 90% TOF after 4mg/kg of sugammadex administration [abstract]. In American Society of Anesthesiologists. Annual meeting, 13-17 October 2007. San Francisco, CA; 2007. p. A843.
100. de Boer H, Marcus M, Schouten P, Heeringa M, Driessen J. Reversal of rocuronium-induced (1.2 mg/ kg) neuromuscular block by Org 25969: a multi center dose finding and safety study [abstract]. In American Society of Anesthesiologists. Annual meeting, 21-26 October 2005. Atlanta, GA; 2005. p. A1117.
101. Flockton E, Scanni E, Gomar C, Shields M, Aguilera L. Sugammadex after rocuronium provides faster recovery from neuromuscular blockade than neostigmine after cisatracurium [abstract]. Eur J Anaesthesiol 2007;24:123.
102. Khuenl-Brady K, Rex C, Sielenkamper A, Kjaer CC, Eikermann M, Larsen PB, et al. Reversal of highdose rocuronium with Org 25969 [abstract]. Eur J Anaesthesiol 2005;22:121.
103. Rex C, Khuenl-Brady K, Sielenkaemper A, Kjaer CC, Puehringer FK. Reversal of high-dose rocuronium (1.2 mg/kg) with org 25969 [abstract]. In American Society of Anesthesiologists. Annual meeting; 21-26 October 2005. Atlanta, GA; 2005. p. A1129.
104. Sorgenfrei I, Larsen PB, Norrild K, Stensballe J, Ostergaard D, Prins ME, et al. Rapid reversal ofrocuronium by the cyclodextrine ORG 25969: a two centre dose finding and safety study [abstract]. Eur J Anaesthesiol 2004;21:140.
105. Vermeyen KM, Sparr HJ, Beaufort AM, Houwing NS, Saldien V, Velich-Salchner C, et al. Reversal of rocuronium induced neuromuscular block by Org 25969: pharmacokinetics [abstract]. Eur J Anaesthesiol 2004;21:141.
106. Suy K, Morias K, Hans P, Heeringa M, Demeyer I. Fast, effective and safe reversal of rocuronium and vecuronium-induced moderate neuromuscular block by the selective relaxant binding agent org 25969 [abstract]. In American Society of Anesthesiologists. Annual meeting; 21-26 October 2005. Atlanta, GA; 2005. p. A1119.
107. Organon. A bridging trial comparing Org 25969 at reappearance of T2 in Japanese and Caucasian subjects. Part B: Caucasian subjects (19.4.208B). In: ClinicalTrials.gov (internet). Bethesda, MD: National Library of Medicine (US). 2005-2006. Accessed 30 May 2008. URL: http://clinicaltrials.gov/show/NCT00552617NLMIdentifier:NCT00552617