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An appraisal of neostigmine versus sugammadex for neuromuscular blockade reversal in patients with a prior heart transplant
BACKGROUND: Heart transplant recipients present unique perioperative challenges for surgery. Specifically, autonomic system denervation has significant implications for commonly used perioperative drugs. This study investigates neuromuscular blocking antagonists in this population when undergoing su...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Termedia Publishing House
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10156568/ https://www.ncbi.nlm.nih.gov/pubmed/37306271 http://dx.doi.org/10.5114/ait.2023.125337 |
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author | Paredes, Stephania Torres, Vivian Hernandez Chaves-Cardona, Harold Matus, Mark Porter, Steven B. Renew, Johnathan Ross |
author_facet | Paredes, Stephania Torres, Vivian Hernandez Chaves-Cardona, Harold Matus, Mark Porter, Steven B. Renew, Johnathan Ross |
author_sort | Paredes, Stephania |
collection | PubMed |
description | BACKGROUND: Heart transplant recipients present unique perioperative challenges for surgery. Specifically, autonomic system denervation has significant implications for commonly used perioperative drugs. This study investigates neuromuscular blocking antagonists in this population when undergoing subsequent non-cardiac surgery. METHODS: A retrospective review was performed for the period 2015–2019 across our health care enterprise. Patients with previous orthotopic heart transplant and subsequent non-cardiac surgery were identified. A total of 185 patients were found, 67 receiving neostigmine (NEO) and 118 receiving sugammadex (SGX). Information of patient characteristics, prior heart transplant, and subsequent non-cardiac surgery was collected. Our primary outcome was the incidence of bradycardia (heart rate < 60 bpm) and/or hypotension (mean blood pressure (MAP) < 65 mmHg) following neuromuscular blockade reversal. Secondary outcomes included need of intra-operative inotropic agents, arrhythmia, cardiac arrest, hospital length of stay (hLOS), ICU admission, and death within 30 postoperative days. RESULTS: In unadjusted analysis, no significant differences were found between the two groups in change in heart rate [0 (–26, 14) vs. 1 (–19, 10), P = 0.59], change in MAP [0 (–22, 28) vs. 0 (–40, 47), P = 0.96], hLOS [2 days (1, 72) vs. 2 (0, 161), P = 0.92], or intraoperative hypotension [4 (6.0%) vs. 5 (4.2%), OR = 0.70, P = 0.60] for NEO and SGX respectively. After multivariable analysis, the results were similar for change in heart rate (P = 0.59) and MAP (P = 0.90). CONCLUSIONS: No significant differences in the incidence of bradycardia and hypotension were found in the NEO versus SGX groups. NEO and SGX may have similar safety profiles in patients with prior heart transplant undergoing non-cardiac surgery. |
format | Online Article Text |
id | pubmed-10156568 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Termedia Publishing House |
record_format | MEDLINE/PubMed |
spelling | pubmed-101565682023-05-17 An appraisal of neostigmine versus sugammadex for neuromuscular blockade reversal in patients with a prior heart transplant Paredes, Stephania Torres, Vivian Hernandez Chaves-Cardona, Harold Matus, Mark Porter, Steven B. Renew, Johnathan Ross Anaesthesiol Intensive Ther Original and Clinical Articles BACKGROUND: Heart transplant recipients present unique perioperative challenges for surgery. Specifically, autonomic system denervation has significant implications for commonly used perioperative drugs. This study investigates neuromuscular blocking antagonists in this population when undergoing subsequent non-cardiac surgery. METHODS: A retrospective review was performed for the period 2015–2019 across our health care enterprise. Patients with previous orthotopic heart transplant and subsequent non-cardiac surgery were identified. A total of 185 patients were found, 67 receiving neostigmine (NEO) and 118 receiving sugammadex (SGX). Information of patient characteristics, prior heart transplant, and subsequent non-cardiac surgery was collected. Our primary outcome was the incidence of bradycardia (heart rate < 60 bpm) and/or hypotension (mean blood pressure (MAP) < 65 mmHg) following neuromuscular blockade reversal. Secondary outcomes included need of intra-operative inotropic agents, arrhythmia, cardiac arrest, hospital length of stay (hLOS), ICU admission, and death within 30 postoperative days. RESULTS: In unadjusted analysis, no significant differences were found between the two groups in change in heart rate [0 (–26, 14) vs. 1 (–19, 10), P = 0.59], change in MAP [0 (–22, 28) vs. 0 (–40, 47), P = 0.96], hLOS [2 days (1, 72) vs. 2 (0, 161), P = 0.92], or intraoperative hypotension [4 (6.0%) vs. 5 (4.2%), OR = 0.70, P = 0.60] for NEO and SGX respectively. After multivariable analysis, the results were similar for change in heart rate (P = 0.59) and MAP (P = 0.90). CONCLUSIONS: No significant differences in the incidence of bradycardia and hypotension were found in the NEO versus SGX groups. NEO and SGX may have similar safety profiles in patients with prior heart transplant undergoing non-cardiac surgery. Termedia Publishing House 2023-03-02 /pmc/articles/PMC10156568/ /pubmed/37306271 http://dx.doi.org/10.5114/ait.2023.125337 Text en Copyright © Polish Society of Anaesthesiology and Intensive Therapy https://creativecommons.org/licenses/by-nc-sa/4.0/This is an Open Access journal, all articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0). License (http://creativecommons.org/licenses/by-nc-sa/4.0/ (https://creativecommons.org/licenses/by-nc-sa/4.0/) ), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license. |
spellingShingle | Original and Clinical Articles Paredes, Stephania Torres, Vivian Hernandez Chaves-Cardona, Harold Matus, Mark Porter, Steven B. Renew, Johnathan Ross An appraisal of neostigmine versus sugammadex for neuromuscular blockade reversal in patients with a prior heart transplant |
title | An appraisal of neostigmine versus sugammadex for neuromuscular blockade reversal in patients with a prior heart transplant |
title_full | An appraisal of neostigmine versus sugammadex for neuromuscular blockade reversal in patients with a prior heart transplant |
title_fullStr | An appraisal of neostigmine versus sugammadex for neuromuscular blockade reversal in patients with a prior heart transplant |
title_full_unstemmed | An appraisal of neostigmine versus sugammadex for neuromuscular blockade reversal in patients with a prior heart transplant |
title_short | An appraisal of neostigmine versus sugammadex for neuromuscular blockade reversal in patients with a prior heart transplant |
title_sort | appraisal of neostigmine versus sugammadex for neuromuscular blockade reversal in patients with a prior heart transplant |
topic | Original and Clinical Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10156568/ https://www.ncbi.nlm.nih.gov/pubmed/37306271 http://dx.doi.org/10.5114/ait.2023.125337 |
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