Association between sugammadex and anaphylaxis in pediatric patients: A nested case‐control study using a national inpatient database

Tadokoro, Fumino; Morita, Kojiro; Michihata, Nobuaki; Fushimi, Kiyohide; Yasunaga, Hideo

doi:10.1111/pan.13401

Cited by 11 publications

(5 citation statements)

References 24 publications

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“…Despite the potential utility of sugammadex in this clinical scenario, its use should be considered carefully, and the risk–benefit ratio determined. Sugammadex itself can cause allergic reactions, the incidence of which is only now being recognized and investigated 34,35 . Sugammadex binds aminosteroid molecules, and there is the potential for sugammadex to bind other steroid molecules including hydrocortisone which may have undesirable physiologic effects, especially in the setting of an allergic reaction.…”

Section: Discussionmentioning

confidence: 99%

“…Sugammadex itself can cause allergic reactions, the incidence of which is only now being recognized and investigated. 34,35 Sugammadex binds aminosteroid molecules, and there intravenous fluids, bronchodilators, corticosteroids, and antihistamines. 5,6,36,37 A systematic approach is necessary for the diagnosis of an intraoperative allergic reaction, confirmation of the offending agent, its management under anesthesia, and the process for appropriate postoperative laboratory and skin testing to guide future anesthetic care.…”

Section: Discussionmentioning

confidence: 99%

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Role of sugammadex in the treatment of anaphylaxis due to rocuronium in children: Extrapolation from adult and animal reports

Ghimire

Olbrecht

Tobias

2022

Pediatric Anesthesia

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Allergic reactions are generalized hypersensitivity processes triggered by different antigenic stimuli, resulting in the end effect of mast cell degranulation and adverse physiologic effects. During the perioperative period, the most commonly identified agents include antibiotics, neuromuscular blocking agents (rocuronium and succinylcholine), chlorhexidine, and iodinated dyes for radiologic imaging. Sugammadex is a novel agent for the reversal of neuromuscular blockade achieved with rocuronium or vecuronium. Its unique mechanism of action, whereby it encapsulates and forms a one-to-one complex with rocuronium, has led to its anecdotal use as an adjunct in the treatment of anaphylactic and anaphylactoid reactions following rocuronium. The current manuscript discusses the potential use of sugammadex in the treatment of allergic reactions following the administration of rocuronium, reviews previous anecdotal reports of its use in these scenarios, and provides recommendations for future care.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Role of sugammadex in the treatment of anaphylaxis due to rocuronium in children: Extrapolation from adult and animal reports

Ghimire

Olbrecht

Tobias

2022

Pediatric Anesthesia

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“…The monitoring period for anaphylaxis extended from the day of rasburicase re-administration to 3 days after exposure when biphasic anaphylaxis was reported [ 8 ]. Anaphylaxis was defined as being assigned the ICD-10 codes for anaphylaxis, either T782 (unspecified anaphylactic shock) or T886 (anaphylactic shock as a side effect of an appropriate drug or a drug properly administered), and being prescribed adrenaline injections during this period [ 9 , 10 ].…”

Section: Methodsmentioning

confidence: 99%

Survey of Anaphylaxis during Rasburicase Re-Administration in Patients with Hematological Malignancies Using a Japanese Claims Database

2022

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Management of tumor lysis syndrome (TLS) associated with cancer chemotherapy for malignant tumors is important because of its potentially fatal course. The use of rasburicase, a recombinant urate oxidase, is recommended for TLS; however, because rasburicase is an enzymatic drug, one should be cautious of anaphylaxis during administration. Using claims data in Japan, we investigated the rate of rasburicase re-administration and the occurrence of anaphylaxis during re-administration in patients with hematopoietic malignancies in a multicenter setting. Re-administration of rasburicase was defined as administration after an interval of 21 days from the first dose. Of 373 patients, 18 were re-administered rasburicase (re-administration rate: 4.8%). No patient developed anaphylaxis. The median number of days from the first to the last dose of rasburicase was 256.5 days (interquartile range: 138.8–455.8 days). The median daily dose was 7.5 mg (4.5–11.3 mg), and the median total dose was 33.8 mg (19.1–64.1 mg). This claims database analysis revealed that the re-administration rate of rasburicase was low in Japanese patients with hematopoietic malignancies, suggesting that rasburicase was being used appropriately, and that associated anaphylaxis was not observed.

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“…However, other investigators have suggested a lower incidence and perhaps one no greater than placebo or neostigmine. 90,91 Future trials are indicated to more clearly define the incidence of allergic reactions including true anaphylaxis with sugammadex. Regardless of its incidence, as with any medication administered perioperatively or to critically ill patients, ongoing patient monitoring is mandatory to allow for prompt recognition and treat of these issues.…”

Section: Miscellaneous Applicationsmentioning

confidence: 99%

Sugammadex: Applications in Pediatric Critical Care

Tobias

2020

J Pediatr Intensive Care

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Sugammadex is a novel pharmacologic agent, which reverses neuromuscular blockade with a mechanism that differs from acetylcholinesterase inhibitors such as neostigmine. There is a growing body of literature demonstrating its efficacy in pediatric patients of all ages. Prospective trials have demonstrated a more rapid and more complete reversal of rocuronium-induced neuromuscular blockade than the acetylcholinesterase inhibitor, neostigmine. Unlike the acetylcholinesterase inhibitors, sugammadex effectively reverses intense or complete neuromuscular blockade. It may also be effective in situations where reversal of neuromuscular blockade is problematic including patients with neuromyopathic conditions or when acetylcholinesterase inhibitors are contraindicated. This article reviews the physiology of neuromuscular transmission as well as the published literature, regarding the use of sugammadex in pediatric population including the pediatric intensive care unit population. Clinical applications are reviewed, adverse effects are discussed, and dosing algorithms are presented.

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Association between sugammadex and anaphylaxis in pediatric patients: A nested case‐control study using a national inpatient database

Abstract: The present study showed no significant association between sugammadex and perioperative anaphylaxis in pediatric patients who underwent general anesthesia.

Cited by 11 publications

References 24 publications

Role of sugammadex in the treatment of anaphylaxis due to rocuronium in children: Extrapolation from adult and animal reports

Role of sugammadex in the treatment of anaphylaxis due to rocuronium in children: Extrapolation from adult and animal reports

Survey of Anaphylaxis during Rasburicase Re-Administration in Patients with Hematological Malignancies Using a Japanese Claims Database

Sugammadex: Applications in Pediatric Critical Care

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