Retrospective Investigation of Grafted Kidney Function After Reversal of Neuromuscular Blockade Using Neostigmine or Sugammadex

Arslantaş, Reyhan; Çevik, Banu

doi:10.1016/j.transproceed.2019.03.051

Cited by 6 publications

(6 citation statements)

References 6 publications

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“…No complications definitely, probably, or possibly related to the reversal drug have been reported (Staals et al 2008 ; Staals et al 2010 ; Cammu et al 2012 ; de Souza et al 2015 ; Panhuizen et al 2015 ). In patients undergoing kidney transplantation, successful use of sugammadex for reversal of moderate rocuronium-induced NMB has been reported by retrospective observational studies (Unterbuchner, 2016 ; Ono et al 2018 ; Arslantas and Cevik, 2019 ; Adams et al 2020 ; Paredes et al, 2020 ; Vargas et al 2020 ). Potential effects of sugammadex, or sugammadex-rocuronium complex, on renal function and the risk of postoperative recurrence of NMB are the main concerns about the rocuronium-sugammadex strategy in subjects with ESRD, including those undergoing kidney transplantation.…”

Section: Discussionmentioning

confidence: 99%

“…The safety profile of sugammadex observed in clinical studies involving subjects with severe renal impairment (Staals et al 2008 ; de Souza et al 2015 ) has encouraged its use in clinical practice in patients with ESRD (Adams et al 2020 ; Paredes et al, 2020 ), particularly in those undergoing kidney transplant (Unterbuchner, 2016 ; Ono et al 2018 ; Arslantas and Cevik, 2019 ; Adams et al 2020 ; Vargas et al 2020 ). However, only retrospective analyses including reports (Unterbuchner, 2016 ) or small cohorts of patients are available in the literature (Ono et al 2018 ; Arslantas and Cevik, 2019 ; Adams et al 2020 ; Vargas et al 2020 ). Furthermore, no data exist on the use of sugammadex administered for reversal of deep NMB in patients undergoing kidney transplantation.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Impact on grafted kidney function of rocuronium-sugammadex vs cisatracurium-neostigmine strategy for neuromuscular block management. An Italian single-center, 2014-2017 retrospective cohort case-control study

et al. 2022

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Background The impact of sugammadex in patients with end-stage renal disease undergoing kidney transplantation is still far from being defined. The aim of the study is to compare sugammadex to neostigmine for reversal of rocuronium- and cisatracurium-induced neuromuscular block (NMB), respectively, in patients undergoing kidney transplantation. Methods A single-center, 2014-2017 retrospective cohort case-control study was performed. A total of 350 patients undergoing kidney transplantation, equally divided between a sugammadex group (175 patients) and a neostigmine group (175 patients), were considered. Postoperative kidney function, evaluated by monitoring of serum creatinine and urea and estimated glomerular filtration rate (eGFR), was the endpoint. Other endpoints were anesthetic and surgical times, post-anesthesia care unit length of stay, postoperative intensive care unit admission, and recurrent NMB or complications. Results No significant differences in patient or, with the exception of drugs involved in NMB management, anesthetic, and surgical characteristics, were observed between the two groups. Serum creatinine (median [interquartile range]: 596.0 [478.0-749.0] vs 639.0 [527.7-870.0] μmol/L, p = 0.0128) and serum urea (14.9 [10.8-21.6] vs 17.1 [13.1-22.0] mmol/L, p = 0.0486) were lower, while eGFR (8.0 [6.0-11.0] vs 8.0 [6.0-10.0], p = 0.0473) was higher in the sugammadex group than in the neostigmine group after surgery. The sugammadex group showed significantly lower incidence of postoperative severe hypoxemia (0.6% vs 6.3%, p = 0.006), shorter PACU stay (70 [60-90] min vs 90 [60-105] min, p < 0.001), and reduced ICU admissions (0.6% vs 8.0%, p = 0.001). Conclusions Compared to cisatracurium-neostigmine, the rocuronium-sugammadex strategy for reversal of NMB showed a better recovery profile in patients undergoing kidney transplantation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact on grafted kidney function of rocuronium-sugammadex vs cisatracurium-neostigmine strategy for neuromuscular block management. An Italian single-center, 2014-2017 retrospective cohort case-control study

et al. 2022

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“…The body of evidence enrolling adults included 191 studies (133 randomized controlled trials, 4,59–90,92,95,98–104,110–114,118–127,132–141,145–148,155–157,163,173–181,206–254 11 nonrandomized trials, 17,128,142,182–184,191,255–258 45 cohort studies, 15,42,86,91,93,94,96,97,105–109,116,117,129–131,143,144,186–190,227,259–277 and 2 before–after designs 115,168 ) evaluating efficacy and safety of antagonist drugs for neuromuscular blockade. The randomized controlled trials enrolling only adults had a median of 88 participants (range, 16 to 350).…”

Section: Antagonism Of Neuromuscular Blockadementioning

confidence: 99%

2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade: A Report by the American Society of Anesthesiologists Task Force on Neuromuscular Blockade

Thilen¹,

Weigel²,

Todd³

et al. 2023

Anesthesiology

116

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“…Sugammadex’s effect on grafted (transplanted) kidney function is important and warrants further investigation, in addition to its efficacy and safety in patients undergoing renal transplantation. Given that sugammadex can interact with corticosteroids, which play an important role in immunosuppression in patients undergoing renal transplantation, Arslantas et al [ 20 ] retrospectively investigated whether there are any differences in grafted kidney function in recipients of renal transplantation when sugammadex or neostigmine is administered to the recipient. They reported no significant differences in serum creatinine values, the incidence of acute rejection episodes, graft failure, length of hospital stay, mortality, and graft survival rates until postoperative day 28 between recipients reversed with sugammadex and those reversed with neostigmine.…”

Section: The Use Of Sugammadex In Renal Transplantation Patientsmentioning

confidence: 99%

Sugammadex administration in patients with end-stage renal disease: a narrative review with recommendations

Lim

2023

Anesth Pain Med

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Due to unknown safety concerns, sugammadex should not be administered to patients with end-stage renal disease (ESRD). However, because the supply of benzylisoquinolinium-type neuromuscular blocking agents (NMBAs) has been discontinued, rocuronium is the only non-depolarizing NMBA that can be used in clinical settings in some countries, including South Korea. The administration of sugammadex cannot be avoided to achieve rapid and complete neuromuscular recovery in patients with ESRD or renal transplantation after rocuronium administration. Although there has been a limited number of clinical studies involving the use of sugammadex in patients with ESRD, studies have shown that sugammadex can effectively and safely reverse rocuronium-induced neuromuscular blockade (NMB) in patients with ESRD, however recovery of neuromuscular function in patients with ESRD is slower than in patients with normal renal function. Nonetheless, safety-concerns are yet to be addressed. Considering the small number of clinical studies, high heterogeneity among studies, and insufficient safety information, more extensive data on the efficacy and safety of sugammadex in patients with ESRD are needed. In particular, it is important to secure data on safety, including residual NMB after surgery, recurarization and cardiorespiratory complications, anaphylactic reactions, and long-term morbidity and mortality. Furthermore, anesthesiologists should remember that performing proper quantitative neuromuscular monitoring and neuromuscular management based on the monitoring signs are the most essential requirements when using sugammadex in patients with ESRD.

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Retrospective Investigation of Grafted Kidney Function After Reversal of Neuromuscular Blockade Using Neostigmine or Sugammadex

Cited by 6 publications

References 6 publications

Impact on grafted kidney function of rocuronium-sugammadex vs cisatracurium-neostigmine strategy for neuromuscular block management. An Italian single-center, 2014-2017 retrospective cohort case-control study

Impact on grafted kidney function of rocuronium-sugammadex vs cisatracurium-neostigmine strategy for neuromuscular block management. An Italian single-center, 2014-2017 retrospective cohort case-control study

2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade: A Report by the American Society of Anesthesiologists Task Force on Neuromuscular Blockade

Sugammadex administration in patients with end-stage renal disease: a narrative review with recommendations

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