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. 2023;55(1):46-51.
doi: 10.5114/ait.2023.125337.

An appraisal of neostigmine versus sugammadex for neuromuscular blockade reversal in patients with a prior heart transplant

Stephania Paredes  1 , Vivian Hernandez Torres  2 , Harold Chaves-Cardona  2 , Mark Matus  2 , Steven Porter  2 , Johnathan Ross Renew  2
Affiliations

An appraisal of neostigmine versus sugammadex for neuromuscular blockade reversal in patients with a prior heart transplant

Stephania Paredes et al. Anaesthesiol Intensive Ther. 2023.

Abstract

Introduction: Heart transplant recipients present unique perioperative challenges for surgery. Specifically, autonomic system denervation has significant implications for commonly used perioperative drugs. This study investigates neuromuscular blocking antagonists in this population when undergoing subsequent non-cardiac surgery.

Material and methods: A retrospective review was performed for the period 2015-2019 across our health care enterprise. Patients with previous orthotopic heart transplant and subsequent non-cardiac surgery were identified. A total of 185 patients were found, 67 receiving neostigmine (NEO) and 118 receiving sugammadex (SGX). Information of patient characteristics, prior heart transplant, and subsequent non-cardiac surgery was collected. Our primary outcome was the incidence of bradycardia (heart rate < 60 bpm) and/or hypotension (mean blood pressure (MAP) < 65 mmHg) following neuromuscular blockade reversal. Secondary outcomes included need of intra-operative inotropic agents, arrhythmia, cardiac arrest, hospital length of stay (hLOS), ICU admission, and death within 30 postoperative days.

Results: In unadjusted analysis, no significant differences were found between the two groups in change in heart rate [0 (-26, 14) vs. 1 (-19, 10), P = 0.59], change in MAP [0 (-22, 28) vs. 0 (-40, 47), P = 0.96], hLOS [2 days (1, 72) vs. 2 (0, 161), P = 0.92], or intraoperative hypotension [4 (6.0%) vs. 5 (4.2%), OR = 0.70, P = 0.60] for NEO and SGX respectively. After multivariable analysis, the results were similar for change in heart rate ( P = 0.59) and MAP ( P = 0.90).

Conclusions: No significant differences in the incidence of bradycardia and hypotension were found in the NEO versus SGX groups. NEO and SGX may have similar safety profiles in patients with prior heart transplant undergoing non-cardiac surgery.

Keywords: heart transplant; neostigmine; sugammadex; neuromuscular blockade.

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Conflict of interest statement

J.R.R.: Merck-funded research with funds to employer; speaker for Senzime AB. The other authors do not have any conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flow diagram
FIGURE 2
FIGURE 2
Boxplot of change in heart rate for the neostigmine and sugammadex groups
FIGURE 3
FIGURE 3
Boxplot of change in MAP for the neostigmine and sugammadex groups
See this image and copyright information in PMC

Comment in

References

    1. Tezcan B, Şaylan A, Bölükbaşı D, Koçulu R, Karadeniz Ü. Use of sugammadex in a heart transplant recipient: review of the unique physiology of the transplanted heart. J Cardiothorac Vasc Anesth 2016; 30: 462-465. doi: 10.1053/j.jvca.2015.06.009. - DOI - PubMed
    1. Swami AC, Kumar A, Rupal S, Lata S. Anaesthesia for non-cardiac surgery in a cardiac transplant recipient. Indian J Anaesth 2011; 55: 405-407. doi: 10.4103/0019-5049.84849. - DOI - PMC - PubMed
    1. Barbara DW, Christensen JM, Mauermann WJ, Dearani JA, Hyder JA. The safety of neuromuscular blockade reversal in patients with cardiac transplantation. Transplantation 2016; 100: 2723-2728. doi: 10.1097/TP.0000000000001060. - DOI - PubMed
    1. Uretsky BF, Murali S, Reddy PS, et al. . Development of coronary artery disease in cardiac transplant patients receiving immunosuppressive therapy with cyclosporine and prednisone. Circulation 1987; 76: 827-834. doi: 10.1161/01.cir.76.4.827. - DOI - PubMed
    1. Clark NJ, Martin RD. Anesthetic considerations for patients undergoing cardiac transplantation. J Cardiothorac Anesth 1988; 2: 519-542. doi: 10.1016/0888-6296(88)90235-9. - DOI - PubMed