Sugammadex for reversal of rocuronium-induced neuromuscular blockade in pediatric patients A systematic review and meta-Analysis

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Abstract

Background: Previous studies have shown that sugammadex, a modified g-cyclodextrin, is a well-Tolerated agent for the reversal of neuromuscular blockade (NMB) induced by a steroidal neuromuscular blocking drug in adult patients. However, its use has not been reviewed in pediatric patients. The aim of this meta-Analysis was to evaluate the efficacy and safety of sugammadex in the reversal of rocuronium-induced NMB during surgery under general anesthesia in pediatric patients. Methods: A literature search was performed using the Pubmed, EMBASE: Drugs and pharmacology, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews. Analysis was conducted using RevMan 5.3. Data collected from different trials were pooled; the weighted mean difference or the pooled risk ratio and the corresponding 95% confidence interval (CI) were used for analysis, and heterogeneity (I2) assessment was performed. Results: Six randomized controlled trials comparing 253 pediatric patients (age range, 2-18 years) were included in the final analysis. The mean time taken to reach a train-of-four ratio of ≥0.9 was significantly shorter in the sugammadex groups (2 and 4 mg/kg) than in the control group (neostigmine or placebo), although the heterogeneity was high. The weighted mean differences of the 2 and 4mg/kg sugammadex groups were -7.15 (95% CI: -10.77 to -3.54; I2=96%; P=0.0001) and -17.32 (95% CI: -29.31 to -5.32; I2=98%; P=0.005), respectively. The extubation time in the sugammadex group was shorter than that in the control group; the weighted mean difference of the sugammadex group was -6.00 (95% CI: -11.46 to -0.53; I2=99%; P=0.03). There was no significant difference between the groups in terms of the incidence of postanesthetic adverse events; the pooled risk ratio was 0.67 (95% CI: 0.27-1.71; I2=59%; P=0.41). Conclusion: We suggest that sugammadex is fast and effective in reversing rocuronium-induced NMB in pediatric patients. Although there was no evidence of a higher incidence of adverse events with sugammadex compared to that with neostigmine or placebo, much more data regarding the safety of sugammadex in pediatric patients may be still required.

Original languageEnglish
JournalMedicine (United States)
Volume95
Issue number34
DOIs
Publication statusPublished - 2016 Jan 1

Fingerprint

Neuromuscular Blockade
Meta-Analysis
Pediatrics
Confidence Intervals
Neostigmine
Odds Ratio
Placebos
Safety
Sugammadex
rocuronium
Control Groups
Incidence
Cyclodextrins
PubMed
Pharmaceutical Preparations
General Anesthesia
Randomized Controlled Trials
Databases
Pharmacology

Keywords

  • Adolescent
  • Child
  • Neostigmine
  • Neuromuscular blockade
  • Preschool
  • Reversal
  • Sugammadex

ASJC Scopus subject areas

  • Medicine(all)

Cite this

@article{3e121f6ad05c4820b1a8aeeaa2f3e9b1,
title = "Sugammadex for reversal of rocuronium-induced neuromuscular blockade in pediatric patients A systematic review and meta-Analysis",
abstract = "Background: Previous studies have shown that sugammadex, a modified g-cyclodextrin, is a well-Tolerated agent for the reversal of neuromuscular blockade (NMB) induced by a steroidal neuromuscular blocking drug in adult patients. However, its use has not been reviewed in pediatric patients. The aim of this meta-Analysis was to evaluate the efficacy and safety of sugammadex in the reversal of rocuronium-induced NMB during surgery under general anesthesia in pediatric patients. Methods: A literature search was performed using the Pubmed, EMBASE: Drugs and pharmacology, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews. Analysis was conducted using RevMan 5.3. Data collected from different trials were pooled; the weighted mean difference or the pooled risk ratio and the corresponding 95{\%} confidence interval (CI) were used for analysis, and heterogeneity (I2) assessment was performed. Results: Six randomized controlled trials comparing 253 pediatric patients (age range, 2-18 years) were included in the final analysis. The mean time taken to reach a train-of-four ratio of ≥0.9 was significantly shorter in the sugammadex groups (2 and 4 mg/kg) than in the control group (neostigmine or placebo), although the heterogeneity was high. The weighted mean differences of the 2 and 4mg/kg sugammadex groups were -7.15 (95{\%} CI: -10.77 to -3.54; I2=96{\%}; P=0.0001) and -17.32 (95{\%} CI: -29.31 to -5.32; I2=98{\%}; P=0.005), respectively. The extubation time in the sugammadex group was shorter than that in the control group; the weighted mean difference of the sugammadex group was -6.00 (95{\%} CI: -11.46 to -0.53; I2=99{\%}; P=0.03). There was no significant difference between the groups in terms of the incidence of postanesthetic adverse events; the pooled risk ratio was 0.67 (95{\%} CI: 0.27-1.71; I2=59{\%}; P=0.41). Conclusion: We suggest that sugammadex is fast and effective in reversing rocuronium-induced NMB in pediatric patients. Although there was no evidence of a higher incidence of adverse events with sugammadex compared to that with neostigmine or placebo, much more data regarding the safety of sugammadex in pediatric patients may be still required.",
keywords = "Adolescent, Child, Neostigmine, Neuromuscular blockade, Preschool, Reversal, Sugammadex",
author = "won, {young ju} and Lim, {Byung Gun} and Lee, {Dong Kyu} and Heezoo Kim and Myounghoon Kong and Lee, {Il Ok}",
year = "2016",
month = "1",
day = "1",
doi = "10.1097/MD.0000000000004678",
language = "English",
volume = "95",
journal = "Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries",
issn = "0025-7974",
publisher = "Lippincott Williams and Wilkins",
number = "34",

}

TY - JOUR

T1 - Sugammadex for reversal of rocuronium-induced neuromuscular blockade in pediatric patients A systematic review and meta-Analysis

AU - won, young ju

AU - Lim, Byung Gun

AU - Lee, Dong Kyu

AU - Kim, Heezoo

AU - Kong, Myounghoon

AU - Lee, Il Ok

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Background: Previous studies have shown that sugammadex, a modified g-cyclodextrin, is a well-Tolerated agent for the reversal of neuromuscular blockade (NMB) induced by a steroidal neuromuscular blocking drug in adult patients. However, its use has not been reviewed in pediatric patients. The aim of this meta-Analysis was to evaluate the efficacy and safety of sugammadex in the reversal of rocuronium-induced NMB during surgery under general anesthesia in pediatric patients. Methods: A literature search was performed using the Pubmed, EMBASE: Drugs and pharmacology, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews. Analysis was conducted using RevMan 5.3. Data collected from different trials were pooled; the weighted mean difference or the pooled risk ratio and the corresponding 95% confidence interval (CI) were used for analysis, and heterogeneity (I2) assessment was performed. Results: Six randomized controlled trials comparing 253 pediatric patients (age range, 2-18 years) were included in the final analysis. The mean time taken to reach a train-of-four ratio of ≥0.9 was significantly shorter in the sugammadex groups (2 and 4 mg/kg) than in the control group (neostigmine or placebo), although the heterogeneity was high. The weighted mean differences of the 2 and 4mg/kg sugammadex groups were -7.15 (95% CI: -10.77 to -3.54; I2=96%; P=0.0001) and -17.32 (95% CI: -29.31 to -5.32; I2=98%; P=0.005), respectively. The extubation time in the sugammadex group was shorter than that in the control group; the weighted mean difference of the sugammadex group was -6.00 (95% CI: -11.46 to -0.53; I2=99%; P=0.03). There was no significant difference between the groups in terms of the incidence of postanesthetic adverse events; the pooled risk ratio was 0.67 (95% CI: 0.27-1.71; I2=59%; P=0.41). Conclusion: We suggest that sugammadex is fast and effective in reversing rocuronium-induced NMB in pediatric patients. Although there was no evidence of a higher incidence of adverse events with sugammadex compared to that with neostigmine or placebo, much more data regarding the safety of sugammadex in pediatric patients may be still required.

AB - Background: Previous studies have shown that sugammadex, a modified g-cyclodextrin, is a well-Tolerated agent for the reversal of neuromuscular blockade (NMB) induced by a steroidal neuromuscular blocking drug in adult patients. However, its use has not been reviewed in pediatric patients. The aim of this meta-Analysis was to evaluate the efficacy and safety of sugammadex in the reversal of rocuronium-induced NMB during surgery under general anesthesia in pediatric patients. Methods: A literature search was performed using the Pubmed, EMBASE: Drugs and pharmacology, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews. Analysis was conducted using RevMan 5.3. Data collected from different trials were pooled; the weighted mean difference or the pooled risk ratio and the corresponding 95% confidence interval (CI) were used for analysis, and heterogeneity (I2) assessment was performed. Results: Six randomized controlled trials comparing 253 pediatric patients (age range, 2-18 years) were included in the final analysis. The mean time taken to reach a train-of-four ratio of ≥0.9 was significantly shorter in the sugammadex groups (2 and 4 mg/kg) than in the control group (neostigmine or placebo), although the heterogeneity was high. The weighted mean differences of the 2 and 4mg/kg sugammadex groups were -7.15 (95% CI: -10.77 to -3.54; I2=96%; P=0.0001) and -17.32 (95% CI: -29.31 to -5.32; I2=98%; P=0.005), respectively. The extubation time in the sugammadex group was shorter than that in the control group; the weighted mean difference of the sugammadex group was -6.00 (95% CI: -11.46 to -0.53; I2=99%; P=0.03). There was no significant difference between the groups in terms of the incidence of postanesthetic adverse events; the pooled risk ratio was 0.67 (95% CI: 0.27-1.71; I2=59%; P=0.41). Conclusion: We suggest that sugammadex is fast and effective in reversing rocuronium-induced NMB in pediatric patients. Although there was no evidence of a higher incidence of adverse events with sugammadex compared to that with neostigmine or placebo, much more data regarding the safety of sugammadex in pediatric patients may be still required.

KW - Adolescent

KW - Child

KW - Neostigmine

KW - Neuromuscular blockade

KW - Preschool

KW - Reversal

KW - Sugammadex

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U2 - 10.1097/MD.0000000000004678

DO - 10.1097/MD.0000000000004678

M3 - Article

VL - 95

JO - Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries

JF - Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries

SN - 0025-7974

IS - 34

ER -