Sugammadex use in patients with end-stage renal disease: a historical cohort study

• Published in: Canadian journal of anesthesia Vol. 67; no. 12; pp. 1789 - 1797
• Main Authors: Paredes, Stephania, Porter, Steven B., Porter, Ivan E., Renew, J. Ross
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.12.2020; Springer Nature B.V
• Subjects: Anesthesiology; Cardiology; Cohort analysis; Cohort Studies; Critical Care Medicine; Humans; Intensive; Kidney diseases; Kidney Failure, Chronic - complications; Medicine; Medicine & Public Health; Neostigmine; Neuromuscular Blockade; Pain Medicine; Patients; Pediatrics; Pneumology/Respiratory System; Pneumonia; Reports of Original Investigations; Sugammadex; neuromuscular blockade; chronic kidney disease; patient safety; end-stage renal disease; sugammadex
• ISSN: 0832-610X; 1496-8975
• DOI: 10.1007/s12630-020-01812-3

Purpose While sugammadex (SGX) is not approved for use in patients with end-stage renal disease (ESRD), its administration in this patient population has been reported. We designed the current study to review all instances of patients with ESRD receiving SGX and to describe their clinical outcomes. Methods This is a historical cohort study of 219 patients with chronic kidney disease stage 5 who received SGX in one of three hospital locations within the same academic health system. Data were collected between 7 March 2016 and 1 August 2019 and included demographics, notable events from the anesthesia records, and postoperative complications. The primary outcome included any complication possibly related to SGX such as hypersensitivity reactions, need for reintubation, hypoxemia, pneumonia, and residual neuromuscular blockade. Secondary outcomes included any other complication not included in the primary outcome and/or patient mortality within 30 days after the procedure. Results No patient experienced a hypersensitivity reaction. Three patients required reintubation while two patients developed hypoxemia that did not require reintubation. One patient developed hospital-acquired pneumonia. Fifty (23%) patients developed other postoperative complications (different from our primary outcome) and nine patients (4%) died during the subsequent 30 postoperative days. None of the primary or secondary outcomes appeared to be related to SGX use. Conclusions We provide incremental evidence that SGX could be considered as an alternative neuromuscular blockade reversal agent in patients with ESRD.