背景:Sugammadex逆转了罗库溴铵和维库溴铵诱导的神经肌肉阻滞,并被美国食品和药物管理局批准用于2岁以上的患者。有,然而,关于婴儿和2岁以下儿童的给药概况的数据很少。
目的:本研究的目的是评估复发的风险,或者再次瘫痪,在2岁以下儿童中,提高对适当神经肌肉阻滞监测和逆转的重要性的认识。
方法:所有年龄≤24个月的患者,在2018年1月1日至2021年12月31日期间在三级医疗中心接受手术治疗,并接受罗库溴铵用于神经肌肉阻滞和Sugammadex用于神经肌肉阻滞逆转,在电子病历中被确认.如果患者(1)接受维库溴铵,则将其排除在分析之外,顺式阿曲库铵,阿曲库铵,或琥珀酰胆碱用于神经肌肉阻滞,(2)接受新斯的明逆转,或(3)在24小时内进行了多次手术。我们使用Cox比例风险模型对sugammadex再剂量进行了生存分析。
结果:我们回顾了2923条记录。Sugammadex在123例(4.2%)中重新使用。重新给药的中位数[IQR]时间为7[4-17]分钟,再次给药的中位数[IQR]量为2.74[1.96-3.99]mg/kg。患者年龄(p<0.01)和体重(p<0.01)的增加与sugammadex再给药的危险率降低相关。对于中等体重的患者,年龄从3个月增加到13个月与53%的风险降低相关(HR:0.47;95%CI:0.24~0.91).对于一个中位年龄的病人,体重从4.7kg增加至9.2kg与41%的风险降低相关(HR:0.59;95%CI:0.32~1.07).我们没有发现任何其他关联。
结论:在这个单中心中,儿科手术患者的回顾性队列研究,sugammadex再给药的危险与年龄和体重的增加有关联.
Sugammadex reverses the neuromuscular blockade induced by rocuronium and vecuronium and is approved by the U.S. Food and Drug Administration for use in patients aged over 2 years. There is, however, a paucity of data regarding its dosing profile in infants and children younger than 2 years.
The aim of this study was to assess the risk of recurarization, or re-paralysis, in children under 2 years of age to increase awareness on the importance of appropriate neuromuscular blocked monitoring and reversal.
All patients aged ≤24 months who underwent an operative procedure at a tertiary medical center between January 1, 2018, and December 31, 2021, and received both rocuronium for neuromuscular blockade and sugammadex for neuromuscular blockade reversal, were identified in the electronic medical record. Patients were excluded from analysis if they (1) received vecuronium, cisatracurium, atracurium, or succinylcholine for neuromuscular blockade, (2) received neostigmine for reversal, or (3) underwent more than one operation within 24 h. We performed a survival analysis of sugammadex redose using a Cox proportional hazards model.
We reviewed 2923 records. Sugammadex was redosed in 123 (4.2%) cases. The median [IQR] time to redose was 7 [4-17] min, and the median [IQR] amount of redose administered was 2.74 [1.96-3.99] mg/kg. Increasing patient age (p < .01) and weight (p < .01) were associated with reduced hazard rate of sugammadex redose. For a patient of median weight, increasing age from 3 to 13 months was associated with a 53% risk reduction (HR: 0.47; 95% CI: 0.24-0.91). For a patient of median age, increasing weight from 4.7 to 9.2 kg was associated with 41% risk reduction (HR: 0.59; 95% CI: 0.32-1.07). We failed to detect any other associations.
In this single-center, retrospective cohort study of pediatric surgery patients, there was an association between the hazard of sugammadex redose with both increased age and weight.