Sugammadex Given for Rocuronium-Induced Neuromuscular Blockade in Infants: A Retrospective Study

Sugammadex is a selective muscle relaxant binding agent with a γ-cyclodextrin structure, which reverses rocuroniumand vecuronium-induced neuromuscular blockade by chemical encapsulation. The objective of this retrospective, observational study was to evaluate the efficacy and safety of sugammadex for the reversal of profound neuromuscular blockade by rocuronium in infant patients. Twenty-six infants between the ages of 2 and 12 months (weight, 3–11 kg) with an American Society of Anesthesiologists classification I, II, or III scheduled to undergo neurosurgical procedures were included. The surgeries included in the 26 cases were shunt (n = 12), spinal fusion (n = 6), external ventricular drainage (n = 6), and meningomyelocele repair (n = 2). Anesthesia was induced with 5 mg/kg thiopental, 1 μg/kg fentanyl, and 0.6 mg/kg rocuronium, and sevoflurane was administered to all patients after intubation. Train-of-four (TOF) stimuli acceleromyography was used to monitor the block. If deep neuromuscular block (TOF, 0) persisted at the end of the surgery, 3 mg/kg sugammadex was administered for reversal. The time between sugammadex administration and reversal of the block (TOF ratio, >0.9) was recorded, and complications during and after extubation were noted. The mean recovery time of the TOF ratio of 0.9 was 112.65 ± 35.60 seconds. No clinical evidence of recurarization or residual curarization was observed in this study. The only adverse effects noted were cough in 3 patients and agitation in 2 patients. None of the patients had nausea, vomiting, bradycardia, tachycardia, rash, or hypersensitivity during extubation. The findings of this study support use of sugammadex at a dose of 3 mg/kg as both an effective and safe reversal agent in infants for profound neuromuscular block achieved by rocuronium under sevoflurane anesthesia.