Sugammadex: Eine neue Ära in der Antagonisierung von Muskelrelaxanzien

Zusammenfassung

Cyclodextrine sind ringförmige Zucker mit einem lipophilen Hohlraum und einem hydrophilen Ring. Damit sind sie gut wasserlöslich und besitzen die Eigenschaft steroidale Moleküle zu binden (enkapsulieren). Cyclodextrin wurden nun so modifiziert (=sugamadex), dass eine perfekte Komplexbildung mit Rocuronium resultierte. Damit war eine Alternative zu den klassischen indirekten Antagonisten gefunden. Nun war es möglich, einen neuromuskulären Block nicht durch Eingriffe in den Acetylcholinhaushalt zu beenden, sondern über eine intravasale Enkapsulierung von Rocuronium – fern der neuromuskulären Endplatte und unter Vermeidung der mit Acetylcholinesteraseinhibitoren verbundenen Nebenwirkungen. Ferner zeigte sich, dass über diesen neuartigen Mechanismus auch tiefe neuromuskuläre Blockaden innerhalb von 2 Minuten sicher reversiert werden können.

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