Pediatric anesthesia & critical care
Impact of Sugammadex Introduction on Using Neuromuscular Blockade and Endotracheal Intubation in a Pediatric Hospital: A Retrospective, Observational Cross-Sectional Study
Authors' conclusion
The decision to use NMB medication as part of an anesthetic plan increased substantially after sugammadex became available, particularly in older children and cases staffed by residents. ETT use declined over the study period.
Study context
- Population
- Patients aged 2 to 17 years undergoing GA for surgical cases where anesthesia providers often have discretion over neuromuscular blockade (NMB) medication use or endotracheal tube (ETT) vs laryngeal mask airway (LMA)
- Participants
- 25,638 eligible anesthetics
- Exposure
- Early sugammadex and established sugammadex vs presugammadex periods
- Outcome
- Use of any nondepolarizing NMB medication during the case; use of an ETT vs LMA
Methodological detailsretrospective, observational, single-centre, Generalized linear mixed models used to examine changes in practice patterns over time, Patient and surgical characteristics similar across time periods
- Retrospective
- Observational
- Single-centre
- Generalized linear mixed models used to examine changes in practice patterns over time
- Patient and surgical characteristics similar across time periods
Main finding
As reported in the abstract
NMB medication use
Each group vs presugammadexOdds ratio (95% CI)
Early sugammadex
1.55(1.38–1.75)
Established sugammadex
5.62(4.96–6.37)
Observational data: associations, not effects.
Further findings
| Outcome | OR (95% CI) | |
|---|---|---|
| ETT useEarly sugammadex vs Presugammadex | 0.69 (0.63–0.75) | |
| ETT useEstablished sugammadex vs Presugammadex | 0.71 (0.65–0.78) | |
| NMB medication use by age group and in-room provider (subgroup)Age 6-11 years vs Age 2-5 years | 1.81 (1.63–2.01) | |
| NMB medication use by age group and in-room provider (subgroup)Age 12-17 years vs Age 2-5 years | 7.01 (6.19–7.92) | |
| NMB medication use by age group and in-room provider (subgroup)Resident vs CRNA · primary in-room provider | 1.24 (1.12–1.37) | |
| ETT use by age group and resident presence at induction (subgroup)Age 6-11 years vs Age 2-5 years | 0.45 (0.42–0.49) | |
| ETT use by age group and resident presence at induction (subgroup)Age 12-17 years vs Age 2-5 years | 0.28 (0.25–0.31) | |
| 0.10.31310Odds ratio (log scale) |
ETT use by age group and resident presence at induction (subgroup)
| OR (95% CI) | ||
|---|---|---|
| Resident presence at induction | 1.50 (1.38–1.62) | |
| 0.512Odds ratio (log scale) |
Original publication
Impact of Sugammadex Introduction on Using Neuromuscular Blockade and Endotracheal Intubation in a Pediatric Hospital: A Retrospective, Observational Cross-Sectional Study. Anesth Analg. Published 26 July 2024. doi:10.
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