PDF(Pubmed)
Abstract：
BACKGROUND: Sugammadex is a pharmacologic agent that provides rapid reversal of neuromuscular blockade via encapsulation of the neuromuscular blocking agent (NMBA). The sugammadex-NMBA complex is primarily cleared through glomerular filtration from the kidney, raising the possibility that alterations in renal function could affect its elimination. In pediatric patients, the benefits of sugammadex have led to widespread utilization; however, there is limited information on its application in pediatric renal impairment. This study examined sugammadex use and postoperative outcomes in pediatric patients with severe chronic renal impairment at our quaternary pediatric referral hospital.
METHODS: After IRB approval, we performed a retrospective analysis in pediatric patients with stage IV and V chronic kidney disease who received sugammadex from January 2017 to March 2022. Postoperative outcomes studied included new or increased respiratory requirement, unplanned intensive care unit (ICU) admission, postoperative pneumonia, anaphylaxis, and death within 48 h postoperatively, unplanned deferral of intraoperative extubation, and repeat administrations of NMBA reversal after leaving the operating room.
RESULTS: The final cohort included 17 patients ranging from 8 months to 16 years old. One patient required new postoperative noninvasive ventilation on postoperative day 2, which was credited to hypervolemia. Another patient had bronchospasm intraoperatively resolving with medication, which could not definitively be associated sugammadex administration. There were no instances of deferred extubation, unplanned ICU or need for supplemental oxygen after tracheal extubation identified.
CONCLUSIONS: No adverse effects directly attributable to sugammadex in pediatric patients with severe renal impairment were detected. There may be a role for utilization of sugammadex for neuromuscular reversal in this population.
METHODS: After IRB approval, we performed a retrospective analysis in pediatric patients with stage IV and V chronic kidney disease who received sugammadex from January 2017 to March 2022. Postoperative outcomes studied included new or increased respiratory requirement, unplanned intensive care unit (ICU) admission, postoperative pneumonia, anaphylaxis, and death within 48 h postoperatively, unplanned deferral of intraoperative extubation, and repeat administrations of NMBA reversal after leaving the operating room.
RESULTS: The final cohort included 17 patients ranging from 8 months to 16 years old. One patient required new postoperative noninvasive ventilation on postoperative day 2, which was credited to hypervolemia. Another patient had bronchospasm intraoperatively resolving with medication, which could not definitively be associated sugammadex administration. There were no instances of deferred extubation, unplanned ICU or need for supplemental oxygen after tracheal extubation identified.
CONCLUSIONS: No adverse effects directly attributable to sugammadex in pediatric patients with severe renal impairment were detected. There may be a role for utilization of sugammadex for neuromuscular reversal in this population.
摘要：
背景：Sugammadex是一种通过包封神经肌肉阻断剂（NMBA）快速逆转神经肌肉阻滞的药物。sugammadex-NMBA复合物主要通过肾脏的肾小球过滤清除，增加肾功能改变可能影响其消除的可能性。在儿科患者中，sugammadex的好处导致了广泛的利用；然而，关于其在小儿肾功能损害中的应用信息有限。这项研究在我们的四级儿科转诊医院检查了患有严重慢性肾功能不全的儿科患者的sugammadex使用情况和术后结局。
方法：IRB批准后，我们对2017年1月至2022年3月接受sugammadex治疗的IV期和V期慢性肾病儿科患者进行了回顾性分析.研究的术后结果包括新的或增加的呼吸需求，计划外重症监护病房(ICU)入院,术后肺炎,过敏反应，术后48小时内死亡，术中拔管的非计划延迟，离开手术室后，重复NMBA逆转的管理。
结果：最终队列包括17名8个月至16岁的患者。一名患者在术后第2天需要新的术后无创通气，这归因于高血容量。另一名患者术中使用药物缓解支气管痉挛，这不能明确地与sugammadex管理相关。没有延迟拔管的情况，非计划ICU或气管拔管后需要补充氧气。
结论：在患有严重肾功能损害的儿科患者中，未发现直接归因于sugamadex的不良反应。在该人群中，利用Sugammadex进行神经肌肉逆转可能有作用。
方法：IRB批准后，我们对2017年1月至2022年3月接受sugammadex治疗的IV期和V期慢性肾病儿科患者进行了回顾性分析.研究的术后结果包括新的或增加的呼吸需求，计划外重症监护病房(ICU)入院,术后肺炎,过敏反应，术后48小时内死亡，术中拔管的非计划延迟，离开手术室后，重复NMBA逆转的管理。
结果：最终队列包括17名8个月至16岁的患者。一名患者在术后第2天需要新的术后无创通气，这归因于高血容量。另一名患者术中使用药物缓解支气管痉挛，这不能明确地与sugammadex管理相关。没有延迟拔管的情况，非计划ICU或气管拔管后需要补充氧气。
结论：在患有严重肾功能损害的儿科患者中，未发现直接归因于sugamadex的不良反应。在该人群中，利用Sugammadex进行神经肌肉逆转可能有作用。
