Current evidence for the use of sugammadex in children

Tobias, Joseph D.

doi:10.1111/pan.13050

Cited by 69 publications

(47 citation statements)

References 42 publications

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“…There are few clinical trials reported in the English language of the use of sugammadex in children, which have been reviewed recently by Tobias. 58 Only a dose of 2 mg kg À1 to reverse moderate neuromuscular block is recommended on the sugammadex data sheet for use in paediatric practice in the UK, and the drug does not yet have approval in this country for use in neonates.…”

Section: Reversal Of Neuromuscular Blockmentioning

confidence: 99%

Reversal of residual neuromuscular block: complications associated with perioperative management of muscle relaxation

Hunter

2017

British Journal of Anaesthesia

175

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The use of anticholinesterases to reverse residual neuromuscular block at the end of surgery became routine practice in the 1950s. These drugs could only be used when recovery from block was established [two twitches of the train-of-four (TOF) count detectable] and concern was expressed about their cholinergic side-effects. By the 1990s, it was recognized that failure to reverse residual block adequately to a TOF ratio (TOFR) >0.7 was associated with increased risk of postoperative pulmonary complications (POPCs) following the long-acting non-depolarizing neuromuscular blocking drug (NDNMBD) pancuronium. By 2003, and the introduction of acceleromyography, a TOFR ≥0.9 was considered necessary to protect the airway from aspiration before tracheal extubation. It was also considered that four, not two, twitches of the TOF should be detectable before neostigmine was given. Use of any NDNMBD was subsequently shown to be associated with increased risk of POPCs, but it was thought that neostigmine reduced that risk. Recently, there has been conflicting evidence that use of neostigmine might increase the incidence of POPCs. Although sugammadex has been shown to rapidly reverse profound neuromuscular block from aminosteroidal agents, there is currently no evidence that sugammadex is superior to neostigmine in its effect on POPCs. Other new antagonists, including cysteine to degrade CW002 and calabadion 1 and 2 to antagonize aminosteroidal and benzylisoquinolium NDNMBDs, are being studied in preclinical and clinical trials. Quantitative neuromuscular monitoring is essential whenever a NDNMBD is used to ensure full recovery from neuromuscular block.

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Section: Reversal Of Neuromuscular Blockmentioning

confidence: 99%

Reversal of residual neuromuscular block: complications associated with perioperative management of muscle relaxation

Hunter

2017

British Journal of Anaesthesia

175

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“…Other effects of sugammadex on cardiac conduction include a potential to prolong the QTc interval. 15 In a prospective evaluation of the efficacy of sugammadex in reversing neuromuscular blockade, 176 adult patients anesthetized with propofol were randomly assigned to receive sugammadex (2,4,8,12, or 16 mg/kg) or placebo at 3 or 15 minutes after rocuronium (1 or 1.2 mg/kg) during propofol anesthesia. Although there was prolongation of the QTc interval in 9 patients, this was considered to be related to sugammadex in only 1 patient.…”

Section: Discussionmentioning

confidence: 99%

“…1 Sugammadex (Bridion, Merck & Co, Whitehouse Station, NJ) is a novel pharmacologic agent with a unique mechanism of action for the reversal of neuromuscular blockade. 2 The reader is referred to Tobias 2 for a review of its use in the pediatric population.…”

Section: Introductionmentioning

confidence: 99%

Bradycardia in a Pediatric Heart Transplant Recipient: Is It the Sugammadex?

King

Naguib

Tobias

2017

The Journal of Pediatric Pharmacology and Therapeutics

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Sugammadex is a novel pharmacologic agent that is used to selectively reverse the effects of the neuromuscular blocking agents rocuronium and vecuronium. Various advantages have been reported when comparing its reversal of neuromuscular blockade to that achieved with acetylcholinesterase inhibitors (neostigmine). In heart transplant recipients, bradycardia may occur following the administration of acetylcholinesterase inhibitors, due to the denervation of the heart. Theoretically, the combination of rocuronium and sugammadex could be advantageous in this clinical scenario to avoid the potential bradycardia resulting from neostigmine administration. We present a 10-year-old male who developed profound bradycardia immediately following the administration of intravenous sugammadex. The options for reversal of neuromuscular blockade in heart transplant recipients is discussed, previous reports of bradycardia following sugammadex are presented, and the role of sugammadex in the bradycardia in our patient is reviewed.

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“…However, sugammadex can now be used for rapid restoration of normal neuromuscular function. 45 The importance of considering laryngospasm and effectively treating it have recently been emphasized by an editorial written by Drs. Weiss and Engelhardt.…”

Section: Tablementioning

confidence: 99%

Management of the Difficult Airway in the Pediatric Patient

Krishna

Bryant

Tobias

2018

J Pediatr Intensive Care

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Loss of airway control in children, if not resolved quickly, will lead to devastating consequences. Successful management of the pediatric difficult airway, both anticipated and unanticipated, is facilitated by preprocedure assessment and preparation. Accessibility of and continued hands-on training with modern airway instruments, familiarization with difficult airway guidelines, and collaboration with multidisciplinary airway teams can aid in the management of the difficult pediatric airway. This review outlines the importance of airway assessment and advanced airway equipment for children. It also discusses difficult airway management techniques and algorithms for the management and rescue of the pediatric difficult airway.

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Current evidence for the use of sugammadex in children

Cited by 69 publications

References 42 publications

Reversal of residual neuromuscular block: complications associated with perioperative management of muscle relaxation

Reversal of residual neuromuscular block: complications associated with perioperative management of muscle relaxation

Bradycardia in a Pediatric Heart Transplant Recipient: Is It the Sugammadex?

Management of the Difficult Airway in the Pediatric Patient

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