Patients were recruited consecutively until the sample size was achieved. So, the aim of our study is to evaluate the impact of sugammadex, given at recommended doses for reversal of a moderate or deep rocuronium-induced NMB, compared to neostigmine, administered for reversal of moderate cisatracurium-induced NMB, on renal function in a large cohort of patients undergoing kidney transplantation.Ī total of 350 patients with ESRD undergoing kidney transplantation at our hospital were evaluated. Furthermore, no data exist on the use of sugammadex administered for reversal of deep NMB in patients undergoing kidney transplantation. 2018 Arslantas and Cevik, 2019 Adams et al. However, only retrospective analyses including reports (Unterbuchner, 2016) or small cohorts of patients are available in the literature (Ono et al. 2020 Paredes et al., 2020), particularly in those undergoing kidney transplant (Unterbuchner, 2016 Ono et al. 2015) has encouraged its use in clinical practice in patients with ESRD (Adams et al. The safety profile of sugammadex observed in clinical studies involving subjects with severe renal impairment (Staals et al. At this time, sugammadex administration is not recommended by the manufacturer for subjects with severe renal impairment (creatinine clearance < 30 mL/min), including those undergoing standard forms of dialysis (EMA 2021). Urinary excretion is the main route of elimination of sugammadex and the sugammadex-rocuronium complex. Sugammadex is a highly hydrophilic drug and acts in the plasma by encapsulating and inactivating unbound rocuronium to form a 1:1 water-soluble complex. Compared to neostigmine, an acetylcholinesterase inhibitor traditionally used for reversal of NMB, the use of sugammadex, a modified γ-cyclodextrin developed for the reversal of NMB induced by aminosteroid NMBAs, particularly rocuronium, was associated with a significantly lower incidence of major pulmonary complications (Kheterpal et al. 2020), the choice of reversal drug seems to be no less important (Kheterpal et al. While proper neuromuscular function monitoring is crucial in avoiding postoperative complications, particularly respiratory complications (Blobner et al. However, both are associated with slightly prolonged duration of action and require careful neuromuscular function monitoring for safe recovery at the end of surgery (Della Rocca et al. Cisatracurium seems to benefit from certain favor among anesthesiologists because it is inactivated by Hofmann elimination and hydrolysis by esterases independent of renal function, whereas rocuronium is characterized by organ-independent elimination. There is no evidence supporting the superiority of a specific NMBA. Benzylisoquinolinium compounds, such as cisatracurium, and aminosteroid NMBAs, such as rocuronium, are commonly used during general anesthesia for kidney transplantation. Patients receiving, compared to those not receiving, neuromuscular blocking agents (NMBAs) during general anesthesia are at significantly increased risk of postoperative respiratory complications (adjusted odds ratio : 1.86) (Kirmeier et al. 2013 Mittel and Wagener, 2017) in order to reduce the incidence of complications due to postoperative residual NMB (De Gasperi et al. The management of neuromuscular block (NMB) deserves particular attention (Martinez et al. 2014 Mittel and Wagener, 2017 Wagener et al. A careful anesthetic approach is highly recommended to improve outcomes (Martinez et al. The surgical procedure of kidney transplantation is generally performed under general anesthesia and presents significant challenges for the anesthesiologist (Martinez et al. Kidney transplantation represents the best option to improve survival and quality of life in patients with end-stage renal disease (ESRD) (Kellar, 2015). The Creative Commons Public Domain Dedication waiver ( ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |