Safety of sugammadex for myasthaenia gravis patients undergoing general anaesthesia: a retrospective database study
Background: Using neuromuscular blocking drugs (NMBDs) for patients with myasthaenia gravis remains a challenge in perioperative management. Sugammadex has enabled the safe use of NMBDs. We investigated whether the adverse outcomes, and the treatment used for myasthaenic crises and tracheotomy, are...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-12-01
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| Series: | BJA Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772609622000910 |
| _version_ | 1811196171231690752 |
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| author | Isao Nahara Masato Takeuchi Hiroshi Yonekura Chikashi Takeda Koji Kawakami |
| author_facet | Isao Nahara Masato Takeuchi Hiroshi Yonekura Chikashi Takeda Koji Kawakami |
| author_sort | Isao Nahara |
| collection | DOAJ |
| description | Background: Using neuromuscular blocking drugs (NMBDs) for patients with myasthaenia gravis remains a challenge in perioperative management. Sugammadex has enabled the safe use of NMBDs. We investigated whether the adverse outcomes, and the treatment used for myasthaenic crises and tracheotomy, are affected by NMBD use in patients with myasthaenia gravis under general anaesthesia. Methods: Patients with myasthaenia gravis who underwent general anaesthesia were retrieved from the Diagnostic Procedure Combination/Per-Diem Payment systems in Japan between 1 January 2010 and 30 November 2020. This database did not contain information on the severity of myasthaenia gravis (Osserman classification). Patients who received rocuronium and sugammadex were compared with those who did not receive NMBDs after propensity-score matching. We excluded patients who underwent emergency or cardiac surgery or tracheal intubation before anaesthesia. The primary outcome was receipt of postoperative treatment used for myasthaenic crises. Results: Among 2304 surgical patients with comorbid myasthaenia gravis, propensity-score matching identified 788 patients administered rocuronium and sugammadex and 449 not administered NMBDs. On comparing the treatment used for myasthaenic crises, we found no significant difference between the two groups (6.2% vs 5.3%; hazard ratio, 1.14; 95% confidence interval, 0.70–1.85). Conclusions: Use of rocuronium and sugammadex in patients with myasthaenia gravis did not significantly affect the receipt of postoperative treatment used for myasthaenic crises compared with no use of NMBDs. As well as the severity of myasthaenia gravis was not fully adjusted, it is unclear whether intraoperative administration of rocuronium with the use of sugammadex postoperatively is acceptable and further investigations are needed. |
| first_indexed | 2024-04-12T00:54:06Z |
| format | Article |
| id | doaj.art-e387c4711e0146638dfdf556bf5b1b53 |
| institution | Directory Open Access Journal |
| issn | 2772-6096 |
| language | English |
| last_indexed | 2024-04-12T00:54:06Z |
| publishDate | 2022-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | BJA Open |
| spelling | doaj.art-e387c4711e0146638dfdf556bf5b1b532022-12-22T03:54:40ZengElsevierBJA Open2772-60962022-12-014100092Safety of sugammadex for myasthaenia gravis patients undergoing general anaesthesia: a retrospective database studyIsao Nahara0Masato Takeuchi1Hiroshi Yonekura2Chikashi Takeda3Koji Kawakami4Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, JapanDepartment of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, JapanDepartment of Anesthesiology and Pain Medicine, Fujita Health University Bantane Hospital, Nagoya, JapanDepartment of Anesthesia, Kyoto University Hospital, Kyoto, JapanDepartment of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan; Corresponding author.Background: Using neuromuscular blocking drugs (NMBDs) for patients with myasthaenia gravis remains a challenge in perioperative management. Sugammadex has enabled the safe use of NMBDs. We investigated whether the adverse outcomes, and the treatment used for myasthaenic crises and tracheotomy, are affected by NMBD use in patients with myasthaenia gravis under general anaesthesia. Methods: Patients with myasthaenia gravis who underwent general anaesthesia were retrieved from the Diagnostic Procedure Combination/Per-Diem Payment systems in Japan between 1 January 2010 and 30 November 2020. This database did not contain information on the severity of myasthaenia gravis (Osserman classification). Patients who received rocuronium and sugammadex were compared with those who did not receive NMBDs after propensity-score matching. We excluded patients who underwent emergency or cardiac surgery or tracheal intubation before anaesthesia. The primary outcome was receipt of postoperative treatment used for myasthaenic crises. Results: Among 2304 surgical patients with comorbid myasthaenia gravis, propensity-score matching identified 788 patients administered rocuronium and sugammadex and 449 not administered NMBDs. On comparing the treatment used for myasthaenic crises, we found no significant difference between the two groups (6.2% vs 5.3%; hazard ratio, 1.14; 95% confidence interval, 0.70–1.85). Conclusions: Use of rocuronium and sugammadex in patients with myasthaenia gravis did not significantly affect the receipt of postoperative treatment used for myasthaenic crises compared with no use of NMBDs. As well as the severity of myasthaenia gravis was not fully adjusted, it is unclear whether intraoperative administration of rocuronium with the use of sugammadex postoperatively is acceptable and further investigations are needed.http://www.sciencedirect.com/science/article/pii/S2772609622000910autoimmune diseasegeneral anaesthesiamyasthaenia gravisneuromuscular blocking drugsneuromuscular diseaserocuronium |
| spellingShingle | Isao Nahara Masato Takeuchi Hiroshi Yonekura Chikashi Takeda Koji Kawakami Safety of sugammadex for myasthaenia gravis patients undergoing general anaesthesia: a retrospective database study BJA Open autoimmune disease general anaesthesia myasthaenia gravis neuromuscular blocking drugs neuromuscular disease rocuronium |
| title | Safety of sugammadex for myasthaenia gravis patients undergoing general anaesthesia: a retrospective database study |
| title_full | Safety of sugammadex for myasthaenia gravis patients undergoing general anaesthesia: a retrospective database study |
| title_fullStr | Safety of sugammadex for myasthaenia gravis patients undergoing general anaesthesia: a retrospective database study |
| title_full_unstemmed | Safety of sugammadex for myasthaenia gravis patients undergoing general anaesthesia: a retrospective database study |
| title_short | Safety of sugammadex for myasthaenia gravis patients undergoing general anaesthesia: a retrospective database study |
| title_sort | safety of sugammadex for myasthaenia gravis patients undergoing general anaesthesia a retrospective database study |
| topic | autoimmune disease general anaesthesia myasthaenia gravis neuromuscular blocking drugs neuromuscular disease rocuronium |
| url | http://www.sciencedirect.com/science/article/pii/S2772609622000910 |
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