Maternal and Fetal Outcomes After Sugammadex Use in Pregnant Patients Undergoing Non-Obstetric Surgery: A Retrospective Cohort Study

Abstract

Objective: Sugammadex has been widely studied in pregnant women undergoing cesarean section. However, the use of sugammadex for non-obstetric surgery in pregnant women has not been clearly defined. We aimed to evaluate the effects of sugammadex on the mother and fetus in pregnant women undergoing non-obstetric surgery.
Methods: Pregnant women who underwent non-obstetric surgery between January 2017 and December 2022 under general anesthesia and received sugammadex were included in this retrospective cohort study. Postoperative maternal and fetal complications, delivery method, and neonatal outcomes were analyzed.
Results: In total, 26 patients were included in the study. The mean age was 28.46±5.99, and the mean gestational age at the time of operation was 17.29 ± 7.31. The mean anesthesia duration was 69.46 ± 20.85 minutes. The mean delivery week was 38.23 ± 2.66 weeks. The cesarean delivery rate was 61 %. No abortion or preterm delivery occurred within two weeks after sugammadex usage. The mean neonatal weight was 2940 ± 799 grams, and height was 48.75 ± 3,97 cm. No teratogenic effect was observed.
Conclusions: In this small retrospective cohort, no serious maternal or fetal complications that may be associated with sugammadex have been observed within two weeks of administration. Larger multicenter controlled studies are needed to prove the safety of sugammadex in early pregnancy.

Keywords

• Sugammadex
• Pregnancy
• Non-obstetric surgery
• General anesthesia
• Neuromuscular blockade reversal
• Maternal outcome
• Fetal outcome

References

1. Hristovska AM, Duch P, Allingstrup M, Afshari A. Efficacy and safety of sugammadex versus neostigmine in reversing neuromuscular blockade in adults. Cochrane Database Syst Rev. 2017;8(8):CD012763. doi:10.1002/14651858.CD012763.
2. Stourac P, Adamus M, Seidlova D, Pavlik T, Janku P, Krikava I, et al. Low-dose or high-dose rocuronium reversed with neostigmine or sugammadex for cesarean delivery anesthesia: a randomized controlled noninferiority trial of time to tracheal intubation and extubation. Anesth Analg. 2016;122(5):1536-45. doi:10.1213/ANE.0000000000001197.
3. Varela N, Lobato F. Sugammadex and pregnancy, is it safe?. J Clin Anesth. 2015;27(2):183-4. doi:10.1016/j.jclinane.2014.11.015.
4. Bridion [package insert]. Whitehouse Station, NJ: Merck & Co., Inc.; 2015. https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/022225lbl.pdf
5. Society for Obstetric Anesthesia and Perinatology [cited 2019 July 31]. Available from: https://soap.org/wp-content /uploads/2019/06/SOAP
6. Torres SM, Duarte DF, Glória AS, Reis C, Moreira JF, Cunha S, et al. Sugammadex administration in pregnant patients undergoing non-obstetric surgery: a case series. Braz J Anesthesiol. 2022;72(4):525-528. doi:10.1016/j.bjane.2021.07.034.
7. Singh S, Klumpner TT, Pancaro C, Rajala B, Kountanis JA. Sugammadex administration in pregnant women: a case series of maternal and fetal outcomes. A A Pract. 2021;15(2):e01407. doi:10.1213/XAA.0000000000001407.
8. Williamson RM, Mallaiah S, Barclay P. Rocuronium and sugammadex for rapid sequence induction of obstetric general anaesthesia. Acta Anaesthesiol Scand. 2011;55(6):694-9. doi:10.1111/j.1399-6576.2011.02431.x.

9. Yılmaz R, Uzun ST, Reisli R. Sugammadex for cesarean in a patient with multiple sclerosis. Sisli Etfal Hastan Tip Bul. 2019;53(2):195-8. doi:10.14744/SEMB.2017.07108
10. Nauheimer D, Kollatch C. Geldner G. Modified rapid sequence induction for Cesarean sections: case series on the use of rocuronium and sugammadex. Anaesthetist. 2012;61:691-5. doi:10.1007/s00101-012-2065-6.
11. Sørensen MK, Bretlau C, Gätke MR, Sørensen AM, Rasmussen LS. Rapid sequence induction and intubation with rocuronium-sugammadex compared with succinylcholine: a randomized trial. Br J Anaesth. 2012;108(4):682-9. doi:10.1093/bja/aer503.
12. Karahan MA, Büyükfırat E, Binici O, Uyanıkoğlu H, Incebıyık A, Asoğlu M, et al. The effects of rocuronium-sugammadex on fetomaternal outcomes in pregnancy undergoing electroconvulsive therapy: a retrospective case series and literature review. Cureus. 2019;11(6):e4820. doi:10.7759/cureus.4820.
13. Mirakhur RK. Sugammadex in clinical practice. Anaesthesia. 2009;64 Suppl 1:45-54. doi:10.1111/j.1365-2044.2008.05870.x.
14. Hartman E, Funk E, Dear G, Wellman C, Pereira K. Sugammadex effects on hormonal contraception effectiveness: implementation of uniform postoperative teaching. j perianesth nurs. 2021;36(4):351-8. doi:10.1016/j.jopan.2020.10.007.
15. Rezonja K, Sostaric M, Vidmar G, Mars T. Dexamethasone produces dose dependent inhibition of sugammadex reversal in in vitro innervated primary human muscle cells. Anesth Analg 2014;118:755-63. doi.org/10.1213/ane.0000000000000108.
16. Do W, Cho AR. What we need to know and do on sugammadex usage in pregnant and lactating women and those on hormonal contraceptives. Anesth Pain Med (Seoul). 2023;18(2):114-22. doi:10.17085/apm.23041.
17. Devoy T, Smith N. Sugammadex and oral contraceptives. Curr Opin Anaesthesiol. 2024;37(4):338-43. doi:10.1097/ACO.0000000000001397.
18. Gaston IN, Lange EMS, Farrer JR, Toledo P. Sugammadex use for reversal in nonobstetric surgery during pregnancy: a reexamination of the evidence. Anesth Analg. 2023;136(6):1217-9. doi:10.1213/ANE.0000000000006442.
19. Et T, Topal A, Erol A, Tavlan A, Kılıçaslan A, Uzun ST. The effects of sugammadex on progesterone levels in pregnant rats. Balkan Med J. 2015;32(2):203-7. doi:10.5152/balkanmedj.2015.15502.
20. Büyükerkmen E, Atay E, Firat F, Yüksek A, Bilir A, Albaş Kurt G, et al. Effect of sugammadex administration on neural tube development in 48-h chick embryos. Microsc Res Tech. 2024;87(3):506-15. doi:10.1002/jemt.24452.
21. Ayhan A, Efe E, Fidan PA, Efe OE, Ates EG, Sahinturk F, et al. The influence of different sugammadex doses on neural tube development in early-stage chick embryos. Birth Defects Res. 2023;115(17):1598-607. doi:10.1002/bdr2.2237.
22. Noguchi S, Iwasaki H, Shiko Y, Kawasaki Y, Ishida Y, Shinomiya S, et al. Fetal outcomes with and without the use of sugammadex in pregnant patients undergoing non-obstetric surgery: a multicenter retrospective study. Int J Obstet Anesth. 2023;53:103620. doi:10.1016/j.ijoa.2022.103620.