Pediatric anesthesia & critical care
Factors Associated With Decision to Use and Dosing of Sugammadex in Children: A Retrospective Cross-Sectional Observational Study
Authors' conclusion
Variation in sugammadex use was primarily explained by institution and attending anesthesiologist. Patient factors associated with the decision to use sugammadex included younger age, higher doses of neuromuscular blocking agents, and increased medical complexity.
Study context
- Population
- Children 0 to 17 years at US hospitals, GA with endotracheal intubation and rocuronium or vecuronium, 2016–2020
- Participants
- 97,654 children · 30 institutions
- Exposure
- Sugammadex vs neostigmine; 2 mg/kg vs 4 mg/kg dosing
- Outcome
- Patient, clinician, institution, anesthetic and surgical factors associated with the decision to use sugammadex vs neostigmine
Methodological detailsmulticentre registry (Multicenter Perioperative Outcomes Group (MPOG)), generalized linear mixed models
- Multicentre registry (MPOG)
- Generalized linear mixed models
Main finding
As reported in the abstract
Reversal agent received; variance in sugammadex use and associated factors
Odds ratio (95% CI)P value
Time from first institutional use (per month)sugammadex vs neostigmine
1.08(1.08–1.09)
P < 0.001Age 0-27 days vs 12-17 years
2.59(2.00–3.34)
P < 0.001Age 28 days-1 year vs 12-17 years
2.72(2.16–3.43)
P < 0.001ASA III vs ASA I
1.32(1.23–1.42)
P < 0.001ASA IV vs ASA I
1.71(1.46–2.00)
P < 0.001Neuromuscular disease
1.14(1.04–1.26)
P = 0.006Cardiac surgery
1.76(1.40–2.22)
P < 0.001NMB dose within the hour before reversal >2 ED95s/kg vs none
4.58(4.14–5.07)
P < 0.001Case duration <60 minutes vs >300 minutes
2.06(1.75–2.43)
P < 0.001- Variability in sugammadex use attributable to institution
- 40.4%
- Variability in sugammadex use attributable to attending anesthesiologist
- 27.1%
Observational data: associations, not effects.
Original publication
Factors Associated With Decision to Use and Dosing of Sugammadex in Children: A Retrospective Cross-Sectional Observational Study. Anesth Analg. Published 19 January 2024. doi:10.
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