The efficacy and safety of sugammadex for reversing postoperative residual neuromuscular blockade in pediatric patients: A systematic review

Li, Guangyu; Wang, Rui; Yan, Yanhong; Li, Fan; Xue, Jiang; Wang, Tianlong

doi:10.1038/s41598-017-06159-2

Cited by 35 publications

(34 citation statements)

References 39 publications

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“…Various clinical reports suggested the safety and efficacy of Sugammadex. 116 Hydroxypropyl-and sulphobutyl ether CDs are recognized as safe and used in parenteral solutions. Although these more water-soluble derivatives of CD are well-tolerated ∝-CD, β-CD and methyl-CDs are considered toxic by parenteral route.…”

Section: Safety and Efficacy Aspects Of Cyclodextrin Nanoparticlesmentioning

confidence: 99%

Cyclodextrin Based Nanoparticles for Drug Delivery and Theranostics

2020

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Colloidal nanoparticulate technology has been described in the literature as a versatile drug delivery system. But it possesses some inherent lacunae in their formulation. Cyclodextrins (CDs) have been extensively reported for the solubility enhancement of poorly water-soluble drugs. The CDs can cause intervention in aspects related to nanoparticles (NPs) that include improving drug loading in nano-system, improving stability, site-specific/targeted drug delivery, improving solubility profile and absorption of the drug in nanosystem with consequent improvement in bioavailability, with the possibility of controlled release, safety and efficacy. They find application in for simultaneous diagnosis and therapeutics for better treatment procedures. The current communication is focused on the application of CDs to overcome troubles in nanoparticulate formulation and enhancement of their performance. It also envisages the theranostic aspects of CDs.

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Section: Safety and Efficacy Aspects Of Cyclodextrin Nanoparticlesmentioning

confidence: 99%

Cyclodextrin Based Nanoparticles for Drug Delivery and Theranostics

2020

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“…Sugammadex is a more recent neuromuscular reversal agent that specifically targets aminosteroidal NMBDs [ 82 , 83 ]. A systematic review of randomized controlled trials reported that sugammadex produces more rapid neuromuscular reversal with less bradycardia, as compared to neostigmine and placebo [ 84 ]. The use of a nerve stimulator is important to verify the reversal of neuromuscular blockade and has been shown to be an independent factor in decreasing the risk of PRC [ 81 , 85 , 86 , 87 ].…”

Section: Preoperative Risk Assessment and Stratificationmentioning

confidence: 99%

Recognizing Risks and Optimizing Perioperative Care to Reduce Respiratory Complications in the Pediatric Patient

Egbuta

Mason

2020

JCM

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There have been significant advancements in the safe delivery of anesthesia as well as improvements in surgical technique; however, the perioperative period can still be high risk for the pediatric patient. Perioperative respiratory complications (PRCs) are some of the most common critical events that can occur in pediatric surgical patients and they can lead to increased length of hospitalization, worsened patient outcomes, and higher hospital and postoperative costs. It is important to determine the various factors that put pediatric patients at increased risk of PRCs. This will allow for more detailed and accurate informed consent, optimized perioperative management strategy, improved allocation of clinical resources, and, hopefully, better patient experience. There are only a few risk prediction models/scoring tools developed for and validated in the pediatric patient population, but they have been useful in helping identify the key factors associated with a high likelihood of developing PRCs. Some of these factors are patient factors, while others are procedure-related factors. Some of these factors may be modified such that the patient’s clinical status is optimized preoperatively to decrease the risk of PRCs occurring perioperatively. Fore knowledge of the factors that are not able to be modified can help guide allocation of perioperative clinical resources such that the negative impact of these non-modifiable factors is buffered. Additional training in pediatric anesthesia or focused expertise in pediatric airway management, vascular access and management of massive hemorrhage should be considered for the perioperative management of the less than 3 age group. Intraoperative ventilation strategy plays a key role in determining respiratory outcomes for both adult and pediatric surgical patients. Key components of lung protective mechanical ventilation strategy such as low tidal volume and moderate PEEP used in the management of acute respiratory distress syndrome (ARDS) in pediatric intensive care units have been adopted in pediatric operating rooms. Adequate post-operative analgesia that balances pain control with appropriate mental status and respiratory drive is important in reducing PRCs.

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“…A recent US study in a children's hospital also reported that children who received sugammadex were older and sicker (higher American Society of Anesthesiologists [ASA] score) than children who received neostigmine. 1 There have been systematic reviews which summarized results of randomized clinical trials on the efficacy and safety of sugammadex for reversing postoperative residual neuromuscular blockade in children, 9,10 suggesting sugammadex may be fast and effective in reversing rocuronium/ vecuronium-induced NMB in children. The FDA required postmarking randomized controlled trials among children are currently ongoing and will provide further evidence on the efficacy, safety, and pharmacokinetics of sugammadex in children.…”

Section: Discussionmentioning

confidence: 99%

Neuromuscular Blocking Agents and Reversal Agents Among Hospitalized Children: A Cerner Database Study

et al. 2020

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Background: Sugammadex (Bridion) was approved by the US Food and Drug Administration (FDA) in December 2015 for the reversal of neuromuscular block (NMB) induced by rocuronium and vecuronium bromide in adults undergoing surgery and approved for use in both adults and children in the European Union in 2008. Sugammadex use in children has been reported in the United States, but to what extent is not clear. Aims: The aim was to describe the utilization pattern of NMB agents and factors associated with the use of reversal agents (neostigmine and sugammadex) in US children. Methods: Cross-sectional study of children with exposure to NMB agents between 2015 and 2017 in the Cerner Health Facts® database, which is an electronic health record (EHR) database across 600 facilities in the United States. Logistic regression estimated factors associated with the use of sugammadex vs neostigmine. Results: A total of 27 094 pediatric clinical encounters were exposed to neuromuscular blocking agents (NMBAs), in which 21 845 were exposed to rocuronium (76%), vecuronium (18%), or both (6%). Among children with exposure to rocuronium and vecuronium, the use of sugammadex was 1.7% in 2016 and 7.6% in 2017. The multivariable logistic model suggested that children who were older (age 12-17 years vs 0-1 year; odds ratio [OR] 1.96; 95% confidence interval [CI], 1.36-2.83), Hispanic or Latino ethnicity and other ethnicities (vs non-Hispanic or Latino; OR 2.03 and 1.56; 95% CI, 1.55-2.67 and 1.15-2.13, respectively), in teaching facilities (OR 1.26; 95% CI, 1.00-1.59), or admitted through emergency departments (OR 1.65; 95% CI, 1.06-2.58) were independently more likely to receive sugammadex than neostigmine after controlling for other covariates. Conclusions: In Cerner Health Facts database 2015 to 2017, among children, rocuronium was more commonly used than vecuronium, and sugammadex use was observed since 2016. Sugammadex and neostigmine users varied by demographic, clinical, and site-level characteristics.

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The efficacy and safety of sugammadex for reversing postoperative residual neuromuscular blockade in pediatric patients: A systematic review

Cited by 35 publications

References 39 publications

Cyclodextrin Based Nanoparticles for Drug Delivery and Theranostics

Cyclodextrin Based Nanoparticles for Drug Delivery and Theranostics

Recognizing Risks and Optimizing Perioperative Care to Reduce Respiratory Complications in the Pediatric Patient

Neuromuscular Blocking Agents and Reversal Agents Among Hospitalized Children: A Cerner Database Study

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