Side effects of sugammadex use in pediatric patients

Öz

Objective: It is accepted that sugammadex show its effects more rapidly than the other neuromuscular block antagonists in many studies, however especially in pediatric cases, it is seen that about its reliability and side effects are limited in some studies. In our retrospective study, we aimed to present our experiences on sugammadex in terms of its side effects in the pediatric cases in our hospital for a 1-year period. Methods: The patient files and intraoperative anesthesia records, postoperative 24th hour and after postoperative 24th hour of the cases that underwent the application of sugammadex under general anesthesia in pediatric surgery operating room in a 1-year period were analyzed. Results: Totally 46 patients received sugammadex; infants (28 days-23 months) (n=24), children (2 years-11 years) (n=16) and adolescent (11-17 years) (n=6). None of the patients showed hypersensitivity and statistically significant side effects correlated to sugammadex. Conclusion: We think that sugammadex may open new doors in pediatric patient group with its features. However, more documentation is needed about the safety in pediatric patient group, particularly in infants. J Clin Exp Invest 2013; 4 (3): 265-268

Anahtar Kelimeler

• Sugammadex, pediatric patient, side effect

Pediatrik hastalarda sugammadeks kullanımının yan etkileri

Öz

Amaç: Sugammadeks\'in diğer nöromuskuler blok antagonisti ajanlardan daha hızlı etki gösterdiği yapılan çalışmalarla kabul edilmektedir fakat özellikle pediatrik olgularda güvenilirlik, yan etkileri ile ilgili yapılan çalışmaların sınırlı olduğu görülmektedir. Kliniğimizdeki pediatrik olgularda bir yıllık süredeki sugammadeks deneyimlerimizin yan etkileri bakımından olgu serisi olarak sunulması amaçlanmıştır. Yöntemler: Bir yıllık sürede Tıp Fakültesi ameliyathanesi, çocuk cerrahisi odasında genel anestezi altında sugammadeks uygulanmış olguların dosyaları ve intraoperatif anestezi kayıtları, postoperatif 24 saat ve postoperatif 24 saat sonrası kayıtları incelendi. Bulgular: İnfant (28 gün- 23 ay) (n= 24), çocuk (2 yas- 11 yas) (n= 16), adolesan (11- 17 yas) (n=6) olmak üzere sugammadeks uygulanan toplam hasta sayısı 46 idi. Hastaların hiçbirisinde hipersensitivite bulgularına ve sugammadeks ile ilişkilendirilen istatistiksel anlamlı yan etkiye rastlanmadığı tespit edildi. Sonuç: Sugammadeks\'in sahip olduğu özellikleri ile pediatrik hasta grubunda yeni kapılar açabileceğini düşünmekteyiz. Fakat pediatrik hasta grubunda özellikle infantlarda güvenliği ile ilgili daha fazla dökümantasyona ihtiyaç vardır.

Anahtar Kelimeler

• Sugammadeks, pediatrik hasta, yan etki

Kaynakça

1. Mirakhur R. K. Sugammadex in clinical practice. An- aesthesia 2009;64:45-54.
2. Chambers D, Paulden M, Paton F, et al. Sugammadex for reversal of neuromuscular block after rapid se- quence intubation: a systematic review and economic assessment. Br J Anaesthesia 2010;105:568-575.
3. Sacan O, White PF, Tufanogullari B, et al. Sugamma- dex reversal of rocuronium-induced neuromuscular blockade: a comparison with neostigmine-glyco- pyrrolate and edrophonium-atropine. AnesthAnalg 2007;104:569-574.
4. Welliver M, Cheek D. An update on sugammadex so- dium. AANA Journal 2009;77:219-228.
5. de Boer HD, van Esmond J, Booij LH, Driessen JJ.Reversal of rocuronium-induced profound neuro- muscular block by sugammadex in Duchenne muscu- lar dystrophy. Paediatr Anaesth 2009;19:1226-1228.
6. Meretoja OA. Neuromuscular block and current treat- ment strategies for its reversal in children. Paediatr Anaesth 2010;20:591-604.
7. Glinka L, Onichimowski D, SieniutaP, Korecki A. Su- gammadex-two years in clinical practice. Anaesthe- siol Intensive Therapy 2010;3:139-143.
8. Della Rocca G, Pompei L. A novel approach to rever- sal of neuromuscular blockade. Minerva anestesiol 2009;75:349-51.

9. Tanrıkulu N, Çelik S, Kırbaş A, et al. Sugammadex re- versal of neuromuscular blockade forthy mectomyin a patient with myasthenia gravis. Anatol J Clin Investig 2012;6:48-50.
10. Staals LM, Snoeck MM, Driessen JJ, et al. Multicen- tre, parallel-group, comparative trial evaluating the efficacy and safety of sugammadex in patients with end-stage renal failure or normal renal function. Br J Anaesth 2008;101:492-497.
11. Robertson EN, Driessen JJ, Booij LHDJ. Pharmaco- kinetics and pharmacodynamics of rocuronium in pa- tients with and without renal failure. Eur J Anaesthe- siol 2005;22:4-10.
12. Staals LM, Snoek MM, Flockton EA, et al. The efficacy of sugammadex in subjects with impaired renal func- tion [abstract]. Eur J Anaesthesiol 2007;24:122-123.
13. Shah RR. Drugs, QTc interval prolongation and final ICH E14 guideline: an important milestone with chal- lenges ahead. Drug Safety 2005;28:1009-1028.
14. Amao R, Zornow MH, Cowan RM, et al. Use of su- gammadex in patients with a history of pulmonary dis- ease. J Clin Anesth 2012;24:289-297.
15. Plaud B, Meretoja O, Hofmockel R, et al. Reversal of rocuronium-induced neuromuscular blockade with sugammadex in pediatric and adult surgical patients. Anesthesiology 2009;110:284-294.