Neuromuscular Blockade and Antagonism in Patients with Renal Impairment: A Multicenter Retrospective Cross-sectional Study
Authors' conclusion
Rocuronium-sugammadex is the primary neuromuscular blockade-antagonism strategy for patients with moderate and severe renal impairment. Variation in choice is significantly impacted by the institution and attending anesthesiologist providing care.
Study context
- Population
- Adults (older than 18 yr) with eGFR less than 60 ml/min receiving GA with ETT for a nonrenal transplant procedure, Multicenter Perioperative Outcomes Group (MPOG) registry, January 1, 2016–July 31, 2022
- Participants
- 243,944 cases
- Exposure
- Rocuronium-sugammadex vs cisatracurium-neostigmine vs rocuronium-neostigmine
- Outcome
- Adjusted incidence of each blockade reversal strategy
Methodological detailsmulticentre registry, electronic health record registry, multinomial mixed effects model, multilevel mixed effects models
- Multicentre registry
- Electronic health record registry
- Multinomial mixed effects model
- Multilevel mixed effects models
Main finding
As reported in the abstract
Adjusted use of each strategy (change over study period)
- Rocuronium-sugammadex use increased from 4.4 to 95.2%
- Rocuronium-neostigmine use decreased from 84.7 to 4.3%
- Cisatracurium-neostigmine use decreased from 10.9 to 0.5%
Observational data: associations, not effects.
Further findings
Rocuronium-sugammadex use, eGFR less than 15 ml/min (subgroup)
- Rocuronium-sugammadex use increased from 0.5 to 86.9%
Variation in choice of rocuronium-sugammadex vs cisatracurium-neostigmine
- Attributed to the institution
- 30.1%
- Attributed to the attending anesthesiologist
- 22.7%
- Attributed to patient/case factors or unexplained
- 47.2%
- Adjusted median OR, clinicians
- 2.5
- Adjusted median OR, institutions
- 3.1
Original publication
Neuromuscular Blockade and Antagonism in Patients with Renal Impairment: A Multicenter Retrospective Cross-sectional Study. Anesthesiology. Published 10 February 2025. doi:10.
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