Sugammadex and neuromuscular reversal: special focus on neonatal and infant populations

Abstract

Purpose of review Sugammadex is a novel selective muscle relaxant binding agent capable of reversing deep neuromuscular blockade from rocuronium or vecuronium. It has not been approved for use in children by the US FDA because of lack of literature regarding pediatric patients. Recent findings A series of new studies has reported sugammadex administration to increasingly younger patients ranging in the newborn period. Although the literature in pediatrics is improving, most of the available studies in pediatrics are underpowered, retrospective, and measure too many different variables to draw reliable, collective conclusions. Summary All available evidence suggests that sugammadex is likely well tolerated and effective and can be dosed similarly to adults in patients 2 years’ old and greater. Sugammadex should be used with caution in patients less than 2 years old.

Sugammadex dose in infants

“…Neither the PKPD of rocuronium nor the maturation pharmacokinetics of sugammadex have been described in neonates or infants. Current retrospective reviews suggest prompt antagonism after a larger dose in infants than in adults, 5,6 similar to the findings of Cates et al 4 However, the even more complex models describing sugammadex-rocuronium interactions have not been described in neonates or infants. The pharmacokinetics of neuromuscular blocking drugs can be described using multi-compartment models.…”

Monitorering og reversering av nevromuskulær blokade – en kunnskapsbasert prosedyre

“…Prosedyrens kunnskapsgrunnlag består av en kunnskapsoppsummering med anbefalin ger fra UpToDate (2), en retningslinje (3) og fem oversiktsartikler hvorav to var systema tiske oversiktsartikler (6,9,11,19,20).…”

“…Prosedyrens dosering av sugammadex til barn < 2 år er kvalitetssikret ut fra fors kningsartiklene, et anerkjent medisinsk oppslagsverk og erfaringer fra praksis (19,20,(32)(33)(34).…”

“…Etter et oppdatert litteratursøk i mai 2020 ble tre nye artikler inkludert i prosedyrens kunnskapsgrunnlag(3,19,20). I tillegg var artikkelen fra UpToDate oppdatert siden for rige litteratursøk (2).…”