Heart Rate Changes Following the Administration of Sugammadex to Infants and Children With Comorbid Cardiac, Cardiovascular, and Congenital Heart Diseases

Abstract

Background: Sugammadex is a novel, rapidly-acting pharmacologic agent to reverse steroidal neuromuscular blocking agents with demonstrated advantages over acetylcholinesterase inhibitors. However, anecdotal reports have noted rare instances of bradycardia and even cardiac arrest. The current study examined heart rate (HR) changes in infants and children with comorbid cardiac, cardiovascular, and congenital heart diseases. Methods: Patients less than 18 years of age, who had a comorbid cardiac, cardiovascular, or congenital heart disease and were to receive sugammadex, were included in this prospective observational study. After sugammadex administration, HR was continuously monitored and recorded every minute for the first 15 min, and then every 5 min for the next 15 min or until the patient was transferred from the operating room. The primary outcome, bradycardia, was defined as HR below the fifth percentile for age. Secondary outcomes included greatest decrease in HR from baseline for each patient and interventions required for bradycardia. Results: The study cohort included 99 patients (58 male and 41 female) with a median age of 3 years. Bradycardia was noted in 20 of 99 patients (20%); however, six of these patients were bradycardic prior to the administration of sugammadex. Older patients, male patients , and patients with higher body weight were the most likely to experience bradycardia. None of the patients required treatment for bradycardia. Conclusions: The incidence of bradycardia following the administration of sugammadex was low, even in patients with congenital heart disease. Bradycardia was not associated with clinically significant hemodynamic changes and no treatment was required.

Reversal of Rocuronium-Induced Neuromuscular Blockade by Sugammadex Under Sevoflurane and Desflurane Anesthesia in Children

“…Males with older age or higher BMI were more vulnerable to bradycardia but this situation did not cause hemodynamic impairment and did not require treatment. 19 These results, as well as ours, are encouraging for the use of sugammadex as an agent with low incidences of bradycardia and negative impact on hemodynamics.…”

A Survey of the Society for Pediatric Anesthesia on the Use, Monitoring, and Antagonism of Neuromuscular Blockade

“…The most serious are anaphylactic reactions, including bronchospasm, bradycardia, and asystole, and its potential to reduce the effectiveness of hormonal contraceptives and increase the risk of unintended pregnancy. 13,17,29,30 Our survey results reveal that more than half of respondents use sugammadex in postmenarchal patients and that those who trained after its introduction are more likely to do so. Additionally, almost 40% of the pediatric anesthesiologists in our survey who use sugammadex in this patient population stated that they do not discuss its potential interference with hormonal contraception preoperatively.…”

Comparative study between sugammedex and neostigmine as a reversal agent of rocuronium for pediatric patients 2-12 years old going for surgery under general anaesthesia

“…Furthermore, (42) a prospective observational study (age: 18 years; N=99) on 99 pediatric patients with concomitant cardiac, circulatory, and congenital heart illnesses was conducted. Twenty (20%) patients in all developed bradycardia after receiving sugammadex (six of these patients had bradycardia before re-ceiving sugammadex), but none of the patients needed to be treated for bradycardia (42). A study by (43) examined the efficacy and safety of sugammadex in pediatric patients undergoing surgery.…”