Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2014.03.001
Brazilian Journal of Anesthesiology
Scientific Article

Sugammadex versus neostigmine in pediatric patients: a prospective randomized study

Sugammadex versus neostigmina em pacientes pediátricos: estudo prospectivo e randomizado

Turhan Kara; Ozgur Ozbagriacik; Hacer Sebnem Turk; Canan Tulay Isil; Ozan Gokuc; Oya Unsal; Emrah Seyhan; Sibel Oba

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Abstract

Background and objectives: Acetylcholinesterase inhibitors may cause postoperative residual curarization when they are used for reversal of neuromuscular blockade. Sugammadex reverses neuromuscular blockade by chemical encapsulation and is not associated with the side effects that may occur with the use of anticholinesterase agents. Because of increased outpatient surgical procedures postoperative residual curarization and rapid postoperative recovery have a greater importance in the pediatric patient population. The aim of this study was to compare the efficacy of sugammadex and neostigmine on reversing neuromuscular blockade in pediatric patients undergoing outpatient surgical procedures. Methods: 80 patients, aged 2-12 years, scheduled for outpatient surgery were enrolled in this randomized prospective study. Neuromuscular blockade was achieved with 0.6 mgkg−1 rocuronium and monitorized with train-of-four. Group RN (n = 40) received 0.03 mgkg−1 neostigmine, Group RS (n = 40) received 2 mgkg−1 sugammadex for reversal of rocuronium. Extubation time (time from the reversal of neuromuscular blockade to extubation), train-of-four ratio during this time, time to reach train-of-four > 0.9, and probable complications were recorded. Results: There was no significant difference between the patients' characteristics. Extubation time and time to reach train-of-four > 0.9 were significantly higher in Group RN (p = 0.001, p = 0.002). Train-of-four at the time of neostigmine/sugammadex injection in Group RN were significantly higher than in the RS group (p = 0.020). Extubation train-of-four ratio was significantly lower in Group RN (p = 0.002). Conclusion: Sugammadex provides safer extubation with a shorter recovery time than neostigmine in pediatric patients undergoing outpatient surgical procedures.

Keywords

Sugammadex, Neostigmine, Pediatric

Resumo

Justificativa e objetivos: Os inibidores da acetilcolinesterase podem causar curarização residual no pós-operatório quando usados para reverter o bloqueio neuromuscular. Sugamadex reverte o bloqueio neuromuscular por encapsulação química e não está associado aos efeitos colaterais que podem ocorrer com o uso de agentes anticolinesterase. Devido ao aumento dos procedimentos cirúrgicos ambulatoriais. A curarização residual e a rápida recuperação no pós-operatório são muito importantes para a população de pacientes pediátricos. O objetivo deste estudo foi comparar a eficácia de sugamadex e neostigmina na reversão do bloqueio neuromuscular em pacientes pediátricos submetidos a procedimentos cirúrgicos ambulatoriais. Métodos: 80 pacientes, com idades entre 2-12 anos, programados para cirurgias ambulatoriais foram incluídos neste estudo prospectivo e randomizado. O bloqueio neuromuscular foi obtido com 0,6 mgkg−1 de rocurônio e monitorizado com a interpretação da sequência de quatro estímulos. O Grupo RN (n = 40) recebeu 0,03 mgkg−1 de neostigmina e o Grupo RS (n = 40) recebeu 2 mgkg−1 de sugamadex para a reversão de rocurônio. O tempo de extubacão (tempo desde a reversão do bloqueio neuromuscular até a extubação), a razão da sequência de quatro estímulos durante esse tempo, o tempo para atingir uma sequência de quatro estímulos > 0,9 e as complicações prováveis foram registrados. Resultados: Não houve diferença significativa entre as características dos pacientes. Os tempos de extubação e para atingir uma sequência de quatro estímulos >0,9 foram significativamente maiores no Grupo RN (p = 0,001, p = 0,002). A sequência de quatro estímulos no momento da injeção de neostigmina/sugamadex foi significativamente maior no Grupo RN que no Grupo RS (p = 0,020). A razão entre extubação e sequência de quatro estímulos foi significativamente menor no Grupo RN (p = 0,002). Conclusão: Sugamadex proporciona extubacão mais segura com um tempo de recuperação mais curto que o de neostigmina em pacientes pediátricos submetidos a procedimentos cirúrgicos ambulatoriais.

Palavras-chave

Sugammadex, Neostigmina, Pediatria

References

Naguib M, Kopman AF, Ensor JE. Neuromuscular monitoring and postoperative residual curarization: a meta-analysis. Br J Anaesth. ;98:302-316.

Murphy GS, Szokol JW, Marymont JH. Residual neuromuscular blockade and critical respiratory events in the postanesthesia care unit. Anesth Analg. ;107:130-137.

Naguib M. Pharmacology of muscle relaxant and their antagonist neuromuscular physiology and pharmacology. Anaesthesia. :572-481.

Makri I, Papadima A, Lafioniati A. Sugammadex, a promising reversal drug. A review of clinical trials. Rev Recent Clin Trials. ;6:250-255.

Srivastava A, Hunter JM. Reversal of neuromuscular block. Br J Anaesth. ;103:115-129.

Sparr HJ, Booij LH, Sugammadex Fuchs-Buder T. New pharmacological concept for antagonizing rocuronium and vecuronium. Anaesthesist. ;58:80-66.

Cope TM, Hunter JM. Selecting neuromuscular blocking drugs for elderly patients. Drugs Aging. ;20:125-140.

Meretoja OA. Neuromuscular block and current treatment strategies for its reversal in children. Paediatr Anaesth. ;20:591-604.

Plaud B, Meretoja O, Hofmockel R. Reversal of rocuronium-induced neuromuscular blockade with sugammadex in pediatric and adult surgical patients. Anesthesiology. ;110:294-284.

Bevan DR. Neuromuscular blocking drugs: onset and intubation. J Clin Anesth. ;9:39-36.

Fortier LP, Robitaille R, Donati F. Increased sensitivity to depolarization and nondepolarizing neuromuscular blocking agents in young rat hemidiaphragms. Anesthesiology. ;95:478-484.

Vuksanaj D, Fisher DM. Pharmacokinetics of rocuronium in children aged 4–11 years. Anesthesiology. ;82:1110-1104.

Vuksanaj D, Skjonsby B, Dunbar BS. Neuromuscular effects of rocuronium in children during halothane anaesthesia. Paediatr Anaesth. ;6:281-277.

Fuchs-Buder T, Fink H, Hofmockel R. Application of neuromuscular monitoring in Germany. Anaesthesist. ;57:914-908.

Padjama D, Mantha S. Monitoring of neuromuscular junction. Indian J Anaest. ;46:288-179.

D de Boer H. Sugammadex: a new challenge in neuromuscular management. Anesthesiol Crit Care. ;24:25-20.

Abrishami A, Ho J, Wong J. Sugammadex: a selective reversal medication for preventing postoperative residual neuromuscular blockade. Cochrane Database Syst Rev. ;7:CD007362.

Jones RK, Caldwell JE, Brull SJ. Reversal of profound rocuronium-induced blockade with sugammadex: a randomized comparison with neostigmine. Anesthesiology. ;109:824-816.

Plaud B. Sugammadex: something new to improve patient safety or simply a gadget?. Ann Fr Anesth Reanim. ;28:69-64.

Sorgenfrei IF, Norrild K, Larsen PB. Reversal of rocuronium-induced neuromuscular block by the selective relaxant binding agent sugammadex: dose finding and safety study. Anesthesiology. ;104:667-674.

Schaller SJ, Fink H, Ulm K. Sugammadex and neostigmine dose-finding study for reversal of shallow residual neuromuscu-lar block. Anesthesiology. ;113:1060-1054.

Hogg RM, Mirakhur RK. Sugammadex: a selective relaxant binding agent for reversal of neuromuscular block. Expert Rev Neurother. ;9:599-608.

Debaene B, Meistelman C. Indications and clinical use of sugammadex. Ann Fr Anesth Reanim. ;28:57-63.

Khuenl-Brady KS, Wattwil M, Vanacker BF. Sugammadex provides faster reversal of vecuronium-induced neuromuscular blockade compared with neostigmine: multicentre, randomized controlled triad. Anesth Analg. ;110:73-64.

Blobner M, Eriksson LI, Scholz J. Reversal of rocuronium-induced neuromuscular blockade with sugammadex compared with neostigmine during sevoflurane anaesthesia: results of a randomised, controlled trial. Eur J Anaesthesiol. ;27:874-881.

Delia Rocca G, Pompei L. A novel approach to reversal of neuromuscular blockade. Minerva Anestesiol. ;75:349-351.

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