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. 2024 Jun 10;24(1):206.
doi: 10.1186/s12871-024-02584-9.

Sugammadex use in pediatric patients with stage IV-V chronic kidney disease in a quaternary referral hospital: a case series

Sindhu N Samba  1 , Youssef Daklallah  1 , Sydney E S Brown  1 , Douglas A Colquhoun  2 , Zubin J Modi  3   4 , Rebecca Nause-Osthoff  5
Affiliations

Sugammadex use in pediatric patients with stage IV-V chronic kidney disease in a quaternary referral hospital: a case series

Sindhu N Samba et al. BMC Anesthesiol. .

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.

Conclusion: 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.

Keywords: Chronic kidney disease; Neuromuscular blockade; Outcome; Pediatric; Recurarization; Renal impairment; Sugammadex.

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Conflict of interest statement

Dr. Douglas Colquhoun declares past research support from Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., (Rahway, New Jersey) and current research support from Chiesi USA, Inc (Cary, NC) paid to the University of Michigan unrelated to presented work. Dr Colquhoun reports receiving an honorarium from Medscape, Inc unrelated to presented work.

Figures

Fig. 1
Fig. 1
Study flowchart. CKD = chronic kidney disease. SGM = sugammadex
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References

    1. FDA sugammadex prescribing information available online at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/022225lbl.pdf. Accessed 15 Feb 2023.
    1. Cammu G, Van Vlem B, van den Heuvel M, Stet L, el Galta R, Eloot S, Demeyer I. Dialysability of sugammadex and its complex with rocuronium in intensive care patients with severe renal impairment. Br J Anaesth. 2012;109(3):382–390. doi: 10.1093/bja/aes207. - DOI - PubMed
    1. Oh MW, Mohapatra SG, Pak T, Hermawan A, Chen C, Thota B, et al. Sugammadex versus neostigmine for reversal of neuromuscular blockade in patients with severe renal impairment: a randomized, double-blinded study. Anesth Analg. 2024;138(5):1043–51. - PubMed
    1. Brueckmann B, Sasaki N, Grobara P, Li MK, Woo T, de Bie J, et al. Effects of sugammadex on incidence of postoperative residual neuromuscular blockade: a randomized, controlled study. Br J Anaesth. 2015;115(5):743–751. doi: 10.1093/bja/aev104. - DOI - PubMed
    1. Kheterpal S, Vaughn MT, Dubovoy TZ, Shah NJ, Bash LD, Colquhoun DA, et al. Sugammadex vs neostigmine for reversal of neuromuscular blockade and postoperative pulmonary complications (STRONGER): a multicenter matched cohort analysis. Anesthesiology. 2020;132(6):1371–1381. doi: 10.1097/ALN.0000000000003256. - DOI - PMC - PubMed

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