Marissa Craig, PharmD
UC San Diego Health
San Diego, California
Disclosure information not submitted.
Katrina Derry, BCCCP, BCPS, PharmD
Director Clinical Pharmacy Programs
University of California, Health, California, United States
Disclosure information not submitted.
Brian Frugoni, MD
Associate Clinical Professor of Anesthesiology
UC San Diego Health, United States
Disclosure information not submitted.
jeffrey Ng, n/a
MD
Loma linda university medical center, United States
Disclosure information not submitted.
Kimberly Robbins, MD
Associate Clinical Professor of Anesthesiology and Critical Care Medicine
UC San Diego Health, United States
Disclosure information not submitted.
Title: Evaluation of End-Organ Dysfunction Requiring Supplemental Post-Procedural Sugammadex
INTRODUCTION/HYPOTHESIS: Sugammadex is indicated for the reversal of neuromuscular blockade (NMB) induced by rocuronium or vecuronium. Alterations in NMB metabolism and clearance in hepatic and/or renal dysfunction complicate sugammadex dosing in the post-operative period. Rarely, patients may experience recurarization, necessitating further sugammadex dosing or reintubation. This phenomenon may be attributed to redistribution of NMB from the neuromuscular junction into the plasma due to decreased metabolism or clearance of NMB.
Methods: A retrospective analysis of patients who received sugammadex outside of procedural areas (PAs) between July 2015- November 2020 was conducted to identify patient characteristics in instances when supplemental sugammadex was required following transfer out of a PA. Data points collected from our electronic medical record include sugammadex dose given, NMB type and dose given, time between NMB and sugammadex administration, patient weight and renal function (described as serum creatinine (SCr)), patient’s liver function status (liver failure attributed to prior medical condition, AST/ALT 3x ULN status), and medical note documentation.
Results: Of the 96 patients reviewed, 27% had renal failure (serum creatinine ≥1 mg/dL), 14% had liver failure (prior medical condition, AST/ALT 3x ULN), and 9% had both renal failure and liver failure. Patients who had neither renal failure nor liver failure received a median (IQR) sugammadex dose of 225 mg (200-400 mg) in a PA and 400mg (200-500 mg) outside of a PA. Patients who had renal failure received a median sugammadex dose of 300 mg (275-475 mg) in a PA and 242.5 mg (200-400 mg) outside of a PA. Patients who had liver failure received a median sugammadex dose of 300 mg (250-650 mg) in a PA and 300 mg (200-400 mg) outside of a PA. Patients with neither renal nor liver failure had a median time between NMB and sugammadex administration of 51 minutes (30.5-88 minutes) where patients with renal and liver failure had a median interval of 345 minutes (112-455 minutes).
Conclusions: The presence of renal, hepatic, or renal and hepatic failure increase the need for sugammadex outside of procedural areas. The presence of renal and hepatic failure also increases the time between NMB dosing and sugammadex dosing.