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Sugammadex to Reverse Neuromuscular Blockade Prior to Withdrawal of Life Support

  • Rafael Lemus
    Correspondence
    Address correspondence to: Rafael Lemus, DO, Department of Pediatrics, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
    Affiliations
    Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio, USA
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  • Will Guider
    Affiliations
    Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio, USA

    Division of Pediatric Critical Care Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
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  • Samantha W. Gee
    Affiliations
    Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio, USA

    Division of Pediatric Critical Care Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
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  • Lisa Humphrey
    Affiliations
    Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio, USA

    Division of Palliative Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
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  • Joseph D. Tobias
    Affiliations
    Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio, USA
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      Abstract

      In certain end-of-life scenarios, pharmacologic reversal of neuromuscular blockade may be indicated. However, given the depth of blockade frequently necessitated in the ICU setting, rapid reversal of neuromuscular blockade is generally not feasible with conventional reversal agents such as neostigmine that inhibit acetylcholinesterase. Sugammadex is a novel pharmacologic agent for the reversal of neuromuscular blockade that acts by directly encapsulating steroidal neuromuscular blocking agents and providing effective 1:1 binding of rocuronium or vecuronium. This unique mechanism of action is rapid and allows for complete reversal and recovery of neuromuscular function. We report the use of sugammadex to reverse neuromuscular blockade prior to compassionate extubation in three pediatric patients. Its clinical use in children is reviewed, potential applications in the palliative care arena discussed, and dosing algorithms presented.

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