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

Zhong, Wenjun; Bash, Lori D.; Bortnichak, Ed; Horrow, Jay; Koro, Carol E.

doi:10.1177/0018578720918332

Cited by 3 publications

(2 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This report, together with other sparse data of successful treatment with sugammadex in CICV situations in children, still does not support the use of sugammadex in that particular emergency situation, as the duration of apnea can last for approximately 15 min in 5% of patients [ 45 ]. In the United States, the use of sugammadex in children was only introduced in 2016 [ 46 ].…”

Section: Pediatric Emergenciesmentioning

confidence: 99%

Sugammadex in Emergency Situations

Motamed

2023

JPM

View full text Add to dashboard Cite

Sugammadex may be required or used in multiple emergency situations. Moderate and high doses of this compound can be used inside and outside the operating room setting. In this communication, recent developments in the use of sugammadex for the immediate reversal of rocuronium-induced neuromuscular blockade were assessed. In emergency surgery and other clinical situations necessitating rapid sequence intubation, the tendency to use rocuronium followed by sugammadex instead of succinylcholine has been increasing. In other emergency situations such as anaphylactic shock caused by rocuronium or if intubation or ventilation is not possible, priority should be given to resuming ventilation maintaining hemodynamic stability, in accordance with the traditional guidelines. If necessary for the purpose of resuming ventilation, reversal of neuromuscular blockade should be done in a timely fashion.

show abstract

Section: Pediatric Emergenciesmentioning

confidence: 99%

Sugammadex in Emergency Situations

Motamed

2023

JPM

View full text Add to dashboard Cite

show abstract

“…This discussion is timely because the incidence of perioperative anaphylaxis in general appears to be increasing in the United States 13 . Further, rocuronium is administered frequently to adults 14 and children 15 during the perioperative period, and use of sugammadex (which also can cause anaphylaxis 16 ) is gaining in popularity 17 . Thus, anaphylaxis caused by the administration or reversal of rocuronium is likely to become increasingly common in the future.…”

mentioning

confidence: 99%

Rocuronium‐Induced Anaphylaxis in the Perioperative Period: A Clinical Review

Harris

2023

AORN Journal

View full text Add to dashboard Cite

Rocuronium, a nondepolarizing neuromuscular blocking agent used for muscle relaxation especially during endotracheal intubation, can cause hypersensitivity reactions. This article provides an overview of anaphylactic reactions; risk factors; and the pathophysiology, presentation, diagnosis, treatment, and nursing implications associated with rocuronium‐induced anaphylaxis. Life‐threatening anaphylaxis can be immunoglobulin E–mediated or non–immunoglobulin E‐mediated and usually occurs after the first dose. Anaphylaxis can present with hypotension and bronchospasm; cutaneal symptoms, such as erythema, may not be obvious. Diagnosis is initially presumptive and may require a transesophageal echocardiogram to rule out other causes of hypotension (eg, pulmonary embolus). Emergency treatment begins with epinephrine administration and fluid boluses; cardiac support devices may be needed. Definitive diagnosis requires early measurement of histamine and tryptase levels and skin testing after the patient recovers from the reaction. Perioperative nurses should be prepared to participate in emergency treatment of anaphylaxis and advocate for testing for a definitive diagnosis.

show abstract

Factors Associated With Decision to Use and Dosing of Sugammadex in Children: A Retrospective Cross-Sectional Observational Study

Brown,

Mentz,

Cassidy

et al. 2024

Anesthesia &Amp; Analgesia

View full text Add to dashboard Cite

BACKGROUND: Sugammadex was initially approved for reversal of neuromuscular blockade in adults in the United States in 2015. Limited data suggest sugammadex is widely used in pediatric anesthesia practice however the factors influencing use are not known. We explore patient, surgical, and institutional factors associated with the decision to use sugammadex versus neostigmine or no reversal, and the decision to use 2 mg/kg vs 4 mg/kg dosing. METHODS: Using data from the Multicenter Perioperative Outcomes Group (MPOG) database, an EHR-derived registry, we conducted a retrospective cross-sectional study. Eligible cases were performed between January 1, 2016 and December 31, 2020, for children 0 to 17 years at US hospitals. Cases involved general anesthesia with endotracheal intubation and administration of rocuronium or vecuronium. Using generalized linear mixed models with institution and anesthesiologist-specific random intercepts, we measured the importance of a variety of patient, clinician, institution, anesthetic, and surgical risk factors in the decision to use sugammadex versus neostigmine, and the decision to use a 2 mg/kg vs 4 mg/kg dose. We then used intraclass correlation statistics to evaluate the proportion of variance contributed by institution and anesthesiologist specifically. RESULTS: There were 97,654 eligible anesthetics across 30 institutions. Of these 47.1% received sugammadex, 43.1% received neostigmine, and 9.8% received no reversal agent. Variability in the choice to use sugammadex was attributable primarily to institution (40.4%) and attending anesthesiologist (27.1%). Factors associated with sugammadex use (compared to neostigmine) include time from first institutional use of sugammadex (odds ratio [OR], 1.08, 95% confidence interval [CI], 1.08–1.09, per month, P < .001), younger patient age groups (0–27 days OR, 2.59 [2.00–3.34], P < .001; 28 days–1 year OR, 2.72 [2.16–3.43], P < .001 vs 12–17 years), increased American Society of Anesthesiologists [ASA] physical status (ASA III: OR, 1.32 [1.23–1.42], P < .001 ASA IV OR, 1.71 [1.46–2.00], P < .001 vs ASA I), neuromuscular disease (OR, 1.14 (1.04–1.26], P = .006), cardiac surgery (OR, 1.76 [1.40–2.22], P < .001), dose of neuromuscular blockade within the hour before reversal (>2 ED95s/kg OR, 4.58 (4.14–5.07], P < .001 vs none), and shorter case duration (case duration <60 minutes OR, 2.06 [1.75–2.43], P < .001 vs >300 minutes). CONCLUSIONS: Variation in sugammadex use was primarily explained by institution and attending anesthesiologist. Patient factors associated with the decision to use sugammadex included younger age, higher doses of neuromuscular blocking agents, and increased medical complexity.

show abstract

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

Cited by 3 publications

References 18 publications

Sugammadex in Emergency Situations

Sugammadex in Emergency Situations

Rocuronium‐Induced Anaphylaxis in the Perioperative Period: A Clinical Review

Factors Associated With Decision to Use and Dosing of Sugammadex in Children: A Retrospective Cross-Sectional Observational Study

Contact Info

Product

Resources

About