{"id":19359,"date":"2025-03-16T01:12:27","date_gmt":"2025-03-16T00:12:27","guid":{"rendered":"https:\/\/news-papers.eu\/?p=19359"},"modified":"2025-03-15T11:26:51","modified_gmt":"2025-03-15T10:26:51","slug":"asystolie-nach-sugammadex","status":"publish","type":"post","link":"http:\/\/news-papers.eu\/?p=19359","title":{"rendered":"Asystolie nach Sugammadex"},"content":{"rendered":"<p style=\"text-align: justify;\"><strong>Gastbeitrag von von J\u00fcrgen Knapp und Dominique Engel, Bern\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/strong>Sugammadex ist inzwischen ein weit verbreitetes und beliebtes Medikament zur schnellen Reversion der neuromuskul\u00e4ren Blockade durch Rocuronium und Vecuronium. Es gilt als sehr sicheres Medikament. Dennoch werden zunehmend <strong>seltene, aber schwerwiegende kardiovaskul\u00e4re Ereignisse<\/strong> wie <strong>Bradykardie und Asystolie<\/strong> dokumentiert. Diese treten typischerweise <strong>innerhalb weniger Minuten<\/strong> nach der Verabreichung auf und k\u00f6nnen bei ausbleibender Intervention zu <strong>Herzstillstand<\/strong> f\u00fchren.<\/p>\n<p style=\"text-align: justify;\">Eine gute \u00dcbersicht hierzu bietet folgende Publikation:<\/p>\n<blockquote><p><span class=\"current-selection\" dir=\"ltr\" role=\"presentation\">Kapoor MC<\/span><\/p>\n<p><span class=\"current-selection\" dir=\"ltr\" role=\"presentation\">Cardiovascular adverse effects of <\/span><span class=\"current-selection\" dir=\"ltr\" role=\"presentation\">sugammadex<\/span><\/p>\n<p><a href=\"https:\/\/journals.lww.com\/joacp\/fulltext\/2020\/36040\/cardiovascular_adverse_effects_of_sugammadex.7.aspx\" target=\"_blank\" rel=\"noopener\"><span class=\"current-selection\" dir=\"ltr\" role=\"presentation\">J Anaesthesiol Clin Pharmacol 36: 469-70 (2020)<\/span><\/a><\/p><\/blockquote>\n<p>&nbsp;<\/p>\n<p style=\"text-align: justify;\"><strong>H\u00e4ufigkeit &amp; Klinisches Bild<\/strong><\/p>\n<ul style=\"text-align: justify;\">\n<li><strong>Sehr selten<\/strong>, aber potenziell lebensbedrohlich.<\/li>\n<li>Geht meist mit <strong>ausgepr\u00e4gter Bradykardie<\/strong> einher, gelegentlich <strong>nicht auf Atropin ansprechend<\/strong>.<\/li>\n<li>Der Beginn ist oft <strong>pl\u00f6tzlich, innerhalb von Minuten<\/strong> nach der i.v.-Gabe.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p style=\"text-align: justify;\"><strong>Einige typische, exemplarische Fallberichte<\/strong><strong>:<\/strong><\/p>\n<blockquote><p><strong>Fierro et al. (2021)<\/strong>: Hypotonie, Bradykardie, Asystolie bei \u00e4lterem Patienten<\/p>\n<p><span class=\"csl-entry\"><span class=\"csl-right-inline\">Fierro C <i>et al.<\/i><\/span><\/span><\/p>\n<p><span class=\"csl-entry\"><span class=\"csl-right-inline\">Severe hypotension, bradycardia and asystole after Sugammadex administration in an elderly patient<\/span><\/span><\/p>\n<p><a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC7832398\/\" target=\"_blank\" rel=\"noopener\"><span class=\"csl-entry\"><span class=\"csl-right-inline\">Medicina 57, 79 (2021)<\/span><\/span><\/a><\/p><\/blockquote>\n<p>&nbsp;<\/p>\n<blockquote><p><strong>Lohmeier &amp; Powers (2022)<\/strong>: Pl\u00f6tzliche Asystolie bei jungem, adip\u00f6sem Patienten<\/p>\n<p><span class=\"csl-entry\"><span class=\"csl-right-inline\">Lohmeier SJ, Powers D<\/span><\/span><span class=\"csl-entry\"><span class=\"csl-right-inline\">B\u00a0<\/span><\/span><\/p>\n<p><span class=\"csl-entry\"><span class=\"csl-right-inline\">Sugammadex-associated asystole in young obese patient: Case report<\/span><\/span><\/p>\n<p><a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S221454192200030X\" target=\"_blank\" rel=\"noopener\"><span class=\"csl-entry\"><span class=\"csl-right-inline\">Oral Maxillofac. Surg. Cases 8, 100271 (2022)<\/span><\/span><\/a><\/p><\/blockquote>\n<p>&nbsp;<\/p>\n<blockquote><p><strong>Akkaya et al. (2014)<\/strong>: Asystolie nach 4 mg\/kg, Atropin-responsiv<\/p>\n<p>Bilgi M, Demirhan A, Akkaya A, Tekelioglu UY, Kocoglu H<\/p>\n<p>Sugammadex associated persistent bradycardia<\/p>\n<p><a href=\"https:\/\/www.ijmsph.org\/index.php?mno=48110\" target=\"_blank\" rel=\"noopener\">Int J Med Sci Public Health 2014;3:372-374<\/a><\/p><\/blockquote>\n<p>&nbsp;<\/p>\n<blockquote><p><strong>Sanoja (2019)<\/strong>: Extreme Bradykardie und Herz-Kreislaufstillstan bei 60j\u00e4hrigem Patiente ohne schwere Vorerkrankungen<\/p>\n<p>Sanoja, Ivanna A. MD; Toth, Kenneth S. MD, PhD.<\/p>\n<p>Profound bradycardia and cardiac arrest after Sugammadex administration in a previously healthy patient: A case report.<\/p>\n<p><a href=\"https:\/\/journals.lww.com\/aacr\/fulltext\/2019\/01010\/Profound_Bradycardia_and_Cardiac_Arrest_After.6.aspx\" target=\"_blank\" rel=\"noopener\">A&amp;A Practice 12: 22-24 (2019)<\/a><\/p><\/blockquote>\n<p>&nbsp;<\/p>\n<p style=\"text-align: justify;\"><strong>\u00a0Identifizierte Risikofaktoren f\u00fcr Patienten<\/strong><\/p>\n<table>\n<thead>\n<tr>\n<td><strong>Risikofaktor<\/strong><\/td>\n<td><strong>Erl\u00e4uterung<\/strong><\/td>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td><strong>Kardiovaskul\u00e4re Vorerkrankungen<\/strong><\/td>\n<td>Bradykardie, AV-Block, isch\u00e4mische Herzkrankheit \u2192 reduzierte Herzreserven.<\/td>\n<\/tr>\n<tr>\n<td><strong>Hohes Alter<\/strong><\/td>\n<td>Erh\u00f6hte vagale Aktivit\u00e4t, verlangsamter Stoffwechsel, h\u00f6here Empfindlichkeit.<\/td>\n<\/tr>\n<tr>\n<td><strong>Kinder mit angeborenen Herzfehlern<\/strong><\/td>\n<td>Instabile Autonomregulation, empfindliches Reizleitungssystem.<\/td>\n<\/tr>\n<tr>\n<td><strong>Adipositas<\/strong><\/td>\n<td>Ver\u00e4nderte Pharmakokinetik, \u00dcberdosierung trotz korrekter Berechnung m\u00f6glich.<\/td>\n<\/tr>\n<tr>\n<td><strong>Hohe oder schnelle i.v.-Dosis<\/strong><\/td>\n<td>Kann pl\u00f6tzliche vagale Reizung und Bradykardie\/Asystolie ausl\u00f6sen.<\/td>\n<\/tr>\n<tr>\n<td><strong>Elektrolytst\u00f6rungen<\/strong><\/td>\n<td>Hypokali\u00e4mie, Hypokalz\u00e4mie etc. destabilisieren die Herzleitung.<\/td>\n<\/tr>\n<tr>\n<td><strong>Begleitmedikamente<\/strong><\/td>\n<td>\u03b2-Blocker, Calciumantagonisten, Opioide verst\u00e4rken die Herzverlangsamung.<\/td>\n<\/tr>\n<tr>\n<td><strong>Niedrige Ausgangsherzfrequenz (&lt;60\/min)<\/strong><\/td>\n<td>Erh\u00f6htes Risiko f\u00fcr \u00fcberm\u00e4\u00dfige vagale Reaktion.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p style=\"text-align: justify;\"><strong>M\u00f6gliche Mechanismen<\/strong><\/p>\n<ul style=\"text-align: justify;\">\n<li><strong>Vagale Stimulation<\/strong>: Pl\u00f6tzliche parasympathische Dominanz \u2192 Bradykardie\/Asystolie.<\/li>\n<li><strong>Reizung des kardialen Reizleitungssystems<\/strong> bei empfindlichen Patienten.<\/li>\n<li><strong>Hypersensitivit\u00e4tsreaktionen<\/strong>: In seltenen F\u00e4llen auch durch allergische Reaktionen bedingt.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<blockquote>\n<p style=\"text-align: justify;\"><strong>Klinische Empfehlungen<\/strong><\/p>\n<ol style=\"text-align: justify;\">\n<li><strong>Risikostratifizierung<\/strong>:\n<ul>\n<li>Anamnese, Medikamente, Elektrolytstatus und Herzfrequenz vorab pr\u00fcfen.<\/li>\n<\/ul>\n<\/li>\n<li><strong>Verabreichungshinweise<\/strong>:\n<ul>\n<li>Nicht als Bolus, sondern langsam (\u00fcber 10\u201330 Sekunden) applizieren.<\/li>\n<\/ul>\n<\/li>\n<li><strong>\u00dcberwachung<\/strong>:\n<ul>\n<li>Kontinuierliches EKG-Monitoring f\u00fcr mindestens 5\u201310 Minuten.<\/li>\n<\/ul>\n<\/li>\n<li><strong>Notfallvorsorge<\/strong>:\n<ul>\n<li><strong>Atropin und Adrenalin<\/strong> sollten sofort verf\u00fcgbar sein.<\/li>\n<\/ul>\n<\/li>\n<li><strong>Alternative Strategien<\/strong>:\n<ul>\n<li>Bei Hochrisikopatienten ggf. <strong>Neostigmin<\/strong> erw\u00e4gen.<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n<p style=\"text-align: justify;\">\n<\/blockquote>\n","protected":false},"excerpt":{"rendered":"<p>Gastbeitrag von von J\u00fcrgen Knapp und Dominique Engel, Bern\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Sugammadex ist inzwischen ein weit verbreitetes und beliebtes Medikament zur schnellen Reversion der neuromuskul\u00e4ren Blockade durch Rocuronium und Vecuronium. Es gilt [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":19361,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"__cvm_playback_settings":[],"__cvm_video_id":"","jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"_wpas_customize_per_network":false},"categories":[2,560,188],"tags":[2801,1273,2800,2799],"class_list":["post-19359","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-allgemein","category-pd-dr-knapps-kniffelige-infoecke","category-pharmakologie","tag-asystolie","tag-bradykardie","tag-nebenwirkung","tag-suggamadex"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2025\/03\/suggamadex.png?fit=131%2C276","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p7fR2g-52f","jetpack-related-posts":[{"id":20102,"url":"http:\/\/news-papers.eu\/?p=20102","url_meta":{"origin":19359,"position":0},"title":"Ertrinken als Ursache des pr\u00e4hospitalen Kreislaufstillstandes","author":"Michael Bernhard","date":"November 15, 2025","format":false,"excerpt":"Ertrinken als Ursache des pr\u00e4hospitalen Kreislaufstillstandes Ertrinken ist eine seltene, aber klinisch relevante Ursache des pr\u00e4hospitalen Kreislaufstillstands (OHCA). 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Die\u2026","rel":"","context":"In &quot;Reanimatologie&quot;","block_context":{"text":"Reanimatologie","link":"http:\/\/news-papers.eu\/?cat=137"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2025\/04\/TTE-LVOT.png?fit=1200%2C944&resize=350%2C200","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2025\/04\/TTE-LVOT.png?fit=1200%2C944&resize=350%2C200 1x, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2025\/04\/TTE-LVOT.png?fit=1200%2C944&resize=525%2C300 1.5x, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2025\/04\/TTE-LVOT.png?fit=1200%2C944&resize=700%2C400 2x, https:\/\/i0.wp.com\/news-papers.eu\/wp-content\/uploads\/2025\/04\/TTE-LVOT.png?fit=1200%2C944&resize=1050%2C600 3x"},"classes":[]}],"jetpack_likes_enabled":true,"_links":{"self":[{"href":"http:\/\/news-papers.eu\/index.php?rest_route=\/wp\/v2\/posts\/19359","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/news-papers.eu\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/news-papers.eu\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/news-papers.eu\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/news-papers.eu\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=19359"}],"version-history":[{"count":7,"href":"http:\/\/news-papers.eu\/index.php?rest_route=\/wp\/v2\/posts\/19359\/revisions"}],"predecessor-version":[{"id":19367,"href":"http:\/\/news-papers.eu\/index.php?rest_route=\/wp\/v2\/posts\/19359\/revisions\/19367"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/news-papers.eu\/index.php?rest_route=\/wp\/v2\/media\/19361"}],"wp:attachment":[{"href":"http:\/\/news-papers.eu\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=19359"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/news-papers.eu\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=19359"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/news-papers.eu\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=19359"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}