Decrease in heart rate following the administration of sugammadex in adults.
Anesthesia
neuromuscular blockade reversal
perioperative management
Journal
Journal of anaesthesiology, clinical pharmacology
ISSN: 0970-9185
Titre abrégé: J Anaesthesiol Clin Pharmacol
Pays: India
ID NLM: 9516972
Informations de publication
Date de publication:
Historique:
received:
15
10
2019
revised:
14
03
2020
accepted:
20
09
2020
entrez:
12
4
2021
pubmed:
13
4
2021
medline:
13
4
2021
Statut:
ppublish
Résumé
Sugammadex is a novel agent for reversal of steroidal neuromuscular blocking agents (NMBAs) with potential advantages over acetylcholinesterase inhibitors. In preclinical trials, there have been rare instances of bradycardia with progression to cardiac arrest. To better define this issue, its incidence and mitigating factors, we prospectively evaluated the incidence of bradycardia after sugammadex administration in adults. Patients ≥ 18 years of age who received sugammadex were included in this prospective, open label trial. After administration, heart rate (HR) was continuously monitored. HR was recorded every minute for 15 minutes and then every five minutes for the next 15 minutes or until patient was transferred out of the operating room. Bradycardia was defined as HR less than 60 beats/minute (bpm) or decrease in HR by ≥ 10 beats per minute (bpm) if the baseline HR was <70 bpm. The study cohort included 200 patients. Bradycardia was observed in 13 cases (7%; 95% confidence interval: 4, 11), occurring a median of 4 minutes after sugammadex administration (IQR: 4, 9, range: 2-25). Among patients developing bradycardia, two (15%) had cardiac comorbid conditions. One patient received treatment for bradycardia with ephedrine. No clinically significant blood pressure changes were noted. On bivariate analysis, patients receiving a higher initial sugammadex dose were more likely to develop bradycardia. On multivariable logistic regression, initial sugammadex dose was not associated with the risk of bradycardia. The incidence of bradycardia after administration of sugammadex in our study was low and not associated with significant hemodynamic changes.
Sections du résumé
BACKGROUND AND AIMS
OBJECTIVE
Sugammadex is a novel agent for reversal of steroidal neuromuscular blocking agents (NMBAs) with potential advantages over acetylcholinesterase inhibitors. In preclinical trials, there have been rare instances of bradycardia with progression to cardiac arrest. To better define this issue, its incidence and mitigating factors, we prospectively evaluated the incidence of bradycardia after sugammadex administration in adults.
MATERIAL AND METHODS
METHODS
Patients ≥ 18 years of age who received sugammadex were included in this prospective, open label trial. After administration, heart rate (HR) was continuously monitored. HR was recorded every minute for 15 minutes and then every five minutes for the next 15 minutes or until patient was transferred out of the operating room. Bradycardia was defined as HR less than 60 beats/minute (bpm) or decrease in HR by ≥ 10 beats per minute (bpm) if the baseline HR was <70 bpm.
RESULTS
RESULTS
The study cohort included 200 patients. Bradycardia was observed in 13 cases (7%; 95% confidence interval: 4, 11), occurring a median of 4 minutes after sugammadex administration (IQR: 4, 9, range: 2-25). Among patients developing bradycardia, two (15%) had cardiac comorbid conditions. One patient received treatment for bradycardia with ephedrine. No clinically significant blood pressure changes were noted. On bivariate analysis, patients receiving a higher initial sugammadex dose were more likely to develop bradycardia. On multivariable logistic regression, initial sugammadex dose was not associated with the risk of bradycardia.
CONCLUSION
CONCLUSIONS
The incidence of bradycardia after administration of sugammadex in our study was low and not associated with significant hemodynamic changes.
Identifiants
pubmed: 33840924
doi: 10.4103/joacp.JOACP_346_19
pii: JOACP-36-465
pmc: PMC8022043
doi:
Types de publication
Journal Article
Langues
eng
Pagination
465-469Informations de copyright
Copyright: © 2021 Journal of Anaesthesiology Clinical Pharmacology.
Déclaration de conflit d'intérêts
There are no conflicts of interest.
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