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

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