Management of Neuromuscular Block in Pediatric Patients — Safety Implications

May, Young; Faulk, Debra J.

doi:10.1007/s40140-022-00537-x

Cited by 2 publications

(2 citation statements)

References 72 publications

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“…Studying the recovery of T1 from 25%–75% was very popular until in 2000 it was realized that, with all neuromuscular monitoring techniques, especially with AMG, at least 90% recovery of the TOF ratio was necessary before extubation could be safely performed. Although 90% TOF ratio recovery is currently considered as complete recovery from a neuromuscular block, such data are available only in recent studies 6,147,148 These are not always reported in the summary of product characteristics (SPC) text of NMBAs.…”

Section: Discussionmentioning

confidence: 99%

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Spontaneous recovery from neuromuscular block after a single dose of a muscle relaxant in pediatric patients: A systematic review using a network meta‐analytic and meta‐regression approach

Vanlinthout,

Driessen,

Stolker

et al. 2024

Pediatric Anesthesia

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BackgroundAge‐related differences in the pharmacokinetics and pharmacodynamics of neuromuscular blocking agents (NMBAs) and the short duration of many surgical procedures put pediatric patients at risk of postoperative residual curarization (PORC). To date, the duration of neuromuscular blocking agent effect in children has not been analyzed in a quantitative review. The current meta‐analysis aimed to compare spontaneous recovery following administration of various types and doses of neuromuscular blocking agents and to quantify the effect of prognostic variables associated with the recovery time in pediatric patients.MethodWe searched for randomized controlled trials (RCTs) and controlled clinical trials (CCTs) that compared the time to 25% T1 (t25), from 25% to 75% T1 (RI25–75), and to ≥90% train‐of‐four (tTOF90) neuromuscular recovery between common neuromuscular blocking agent treatments administered as a single bolus to healthy pediatric participants. We compared spontaneous t25, RI25‐75, and tTOF90 between (1) neuromuscular blocking agent treatments and (2) age groups receiving a given neuromuscular blocking agent intervention and anesthesia technique. Bayesian random‐effects network and pairwise meta‐analyses along with meta‐regression were used to evaluate the results.ResultsWe used data from 71 randomized controlled trials/controlled clinical trials including 4319 participants. Network meta‐analysis allowed for the juxtaposition and ranking of spontaneous t25, RI25‐75, and tTOF90 following common neuromuscular blocking agent interventions. For all neuromuscular blocking agents a log‐linear relationship between dose and duration of action was found. With the neuromuscular blocking agent treatments studied, the average tTOF90 (mean[CrI95]) in children (>2–11 y) was 41.96 [14.35, 69.50] and 17.06 [5.99, 28.30] min shorter than in neonates (<28 d) and infants (28 d–12 M), respectively. We found a negative log‐linear correlation between age and duration of neuromuscular blocking agent effect. The difference in the tTOF90 (mean[CrI95]) between children and other age groups increased by 21.66 [8.82, 34.53] min with the use of aminosteroid neuromuscular blocking agents and by 24.73 [7.92, 41.43] min with the addition of sevoflurane/isoflurane for anesthesia maintenance.ConclusionsThe times to neuromuscular recovery are highly variable. These can decrease significantly with age and are prolonged when volatile anesthetics are administered. This variability, combined with the short duration of many pediatric surgical procedures, makes quantitative neuromuscular monitoring mandatory even after a single dose of neuromuscular blocking agent.

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Section: Discussionmentioning

confidence: 99%

“…as complete recovery from a neuromuscular block, such data are available only in recent studies 6,147,148 These are not always reported in the summary of product characteristics (SPC) text of NMBAs.…”

Section: The Interindividual Variation In the Pharmacodynamics Ofmentioning

confidence: 99%

Spontaneous recovery from neuromuscular block after a single dose of a muscle relaxant in pediatric patients: A systematic review using a network meta‐analytic and meta‐regression approach

Vanlinthout,

Driessen,

Stolker

et al. 2024

Pediatric Anesthesia

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Sugammadex for our little ones: a brief narrative review

Lee,

Chung

2024

Anesth Pain Med

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Sugammadex, the first noncompetitive antagonist developed for the reversal of neuromuscular blockade (NMB), is one of the few drugs that has revolutionized anesthetic practice. However, the use of sugammadex for children between the ages of 2 and 17 years has only recently been approved and is currently not approved for children under the age of 2 years. Although the precision and reliability of reversal of NMB with sugammadex are of great benefit in pediatric anesthesia, several important questions remain regarding its use in our youngest patients. In this brief narrative review, we aim to provide an overview of the key considerations and potential challenges that anesthesiologists often face when using sugammadex in pediatric patients.

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Management of Neuromuscular Block in Pediatric Patients — Safety Implications

Cited by 2 publications

References 72 publications

Spontaneous recovery from neuromuscular block after a single dose of a muscle relaxant in pediatric patients: A systematic review using a network meta‐analytic and meta‐regression approach

Spontaneous recovery from neuromuscular block after a single dose of a muscle relaxant in pediatric patients: A systematic review using a network meta‐analytic and meta‐regression approach

Sugammadex for our little ones: a brief narrative review

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