Sims Trent, Peterson Joshua, Hakim Mohammed, Roth Catherine, Tumin Dmitry, Tobias Joseph D, Hansen Jennifer K
Department of Anesthesiology, The University of Kansas, Kansas City, Kansas, USA.
Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.
J Anaesthesiol Clin Pharmacol. 2020 Oct-Dec;36(4):465-469. doi: 10.4103/joacp.JOACP_346_19. Epub 2021 Jan 18.
Sugammadex is a novel agent for reversal of steroidal neuromuscular blocking agents (NMBAs) with potential advantages over acetylcholinesterase inhibitors. In preclinical trials, there have been rare instances of bradycardia with progression to cardiac arrest. To better define this issue, its incidence and mitigating factors, we prospectively evaluated the incidence of bradycardia after sugammadex administration in adults.
Patients ≥ 18 years of age who received sugammadex were included in this prospective, open label trial. After administration, heart rate (HR) was continuously monitored. HR was recorded every minute for 15 minutes and then every five minutes for the next 15 minutes or until patient was transferred out of the operating room. Bradycardia was defined as HR less than 60 beats/minute (bpm) or decrease in HR by ≥ 10 beats per minute (bpm) if the baseline HR was <70 bpm.
The study cohort included 200 patients. Bradycardia was observed in 13 cases (7%; 95% confidence interval: 4, 11), occurring a median of 4 minutes after sugammadex administration (IQR: 4, 9, range: 2-25). Among patients developing bradycardia, two (15%) had cardiac comorbid conditions. One patient received treatment for bradycardia with ephedrine. No clinically significant blood pressure changes were noted. On bivariate analysis, patients receiving a higher initial sugammadex dose were more likely to develop bradycardia. On multivariable logistic regression, initial sugammadex dose was not associated with the risk of bradycardia.
The incidence of bradycardia after administration of sugammadex in our study was low and not associated with significant hemodynamic changes.
舒更葡糖钠是一种新型的甾体类神经肌肉阻滞剂（NMBA）逆转剂，相较于乙酰胆碱酯酶抑制剂具有潜在优势。在临床前试验中，曾有罕见的心动过缓进展为心脏骤停的情况。为了更好地明确这一问题、其发生率及缓解因素，我们前瞻性地评估了成人使用舒更葡糖钠后心动过缓的发生率。
本前瞻性、开放标签试验纳入了年龄≥18岁且接受舒更葡糖钠治疗的患者。给药后，持续监测心率（HR）。前15分钟每分钟记录一次HR，随后15分钟每五分钟记录一次HR，直至患者转出手术室。心动过缓定义为HR低于60次/分钟（bpm），若基线HR<70 bpm，则HR下降≥10次/分钟（bpm）。
研究队列包括200例患者。观察到13例（7%；95%置信区间：4, 11）出现心动过缓，发生时间中位数为舒更葡糖钠给药后4分钟（四分位间距：4, 9，范围：2 - 25）。在发生心动过缓的患者中，2例（15%）有心脏合并症。1例患者接受了麻黄碱治疗心动过缓。未观察到具有临床意义的血压变化。在双变量分析中，初始舒更葡糖钠剂量较高的患者更易发生心动过缓。在多变量逻辑回归分析中，初始舒更葡糖钠剂量与心动过缓风险无关。
在我们的研究中，舒更葡糖钠给药后心动过缓的发生率较低，且与显著的血流动力学变化无关。
