Abstract
BackgroundThe impact of sugammadex in patients with end-stage renal disease undergoing kidney transplantation is still far from being defined. The aim of the study is to compare sugammadex to neostigmine for reversal of rocuronium- and cisatracurium-induced neuromuscular block (NMB), respectively, in patients undergoing kidney transplantation.MethodsA single-center, 2014-2017 retrospective cohort case-control study was performed. A total of 350 patients undergoing kidney transplantation, equally divided between a sugammadex group (175 patients) and a neostigmine group (175 patients), were considered. Postoperative kidney function, evaluated by monitoring of serum creatinine and urea and estimated glomerular filtration rate (eGFR), was the endpoint. Other endpoints were anesthetic and surgical times, post-anesthesia care unit length of stay, postoperative intensive care unit admission, and recurrent NMB or complications.ResultsNo significant differences in patient or, with the exception of drugs involved in NMB management, anesthetic, and surgical characteristics, were observed between the two groups. Serum creatinine (median [interquartile range]: 596.0 [478.0-749.0] vs 639.0 [527.7-870.0] μmol/L, p = 0.0128) and serum urea (14.9 [10.8-21.6] vs 17.1 [13.1-22.0] mmol/L, p = 0.0486) were lower, while eGFR (8.0 [6.0-11.0] vs 8.0 [6.0-10.0], p = 0.0473) was higher in the sugammadex group than in the neostigmine group after surgery. The sugammadex group showed significantly lower incidence of postoperative severe hypoxemia (0.6% vs 6.3%, p = 0.006), shorter PACU stay (70 [60-90] min vs 90 [60-105] min, p < 0.001), and reduced ICU admissions (0.6% vs 8.0%, p = 0.001).ConclusionsCompared to cisatracurium-neostigmine, the rocuronium-sugammadex strategy for reversal of NMB showed a better recovery profile in patients undergoing kidney transplantation.
Highlights
Kidney transplantation represents the best option to improve survival and quality of life in patients with endstage renal disease (ESRD) (Kellar, 2015).The surgical procedure of kidney transplantation is generally performed under general anesthesia and presents significant challenges for the anesthesiologist (Martinez et al 2013)
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
An acetylcholinesterase inhibitor traditionally used for reversal of neuromuscular block (NMB), the use of sugammadex, a modified γ-cyclodextrin developed for the reversal of NMB induced by aminosteroid Neuromuscular block agent (NMBA), rocuronium, was associated with a significantly lower incidence of major pulmonary complications (Kheterpal et al 2020)
Summary
Kidney transplantation represents the best option to improve survival and quality of life in patients with endstage renal disease (ESRD) (Kellar, 2015).The surgical procedure of kidney transplantation is generally performed under general anesthesia and presents significant challenges for the anesthesiologist (Martinez et al 2013). 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 [aOR]: 1.86) (Kirmeier et al 2019) Benzylisoquinolinium compounds, such as cisatracurium, and aminosteroid NMBAs, such as rocuronium, are commonly used during general anesthesia for kidney transplantation. 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 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 2003; Martinez et al 2013; Mittel and Wagener, 2017). The aim of the study is to compare sugammadex to neostigmine for reversal of rocuronium- and cisatracurium-induced neuromuscular block (NMB), respectively, in patients undergoing kidney transplantation
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