Neuromuscular Blockade and Antagonism in Patients with Renal Impairment: A Multicenter Retrospective Cross-sectional Study

作者：Rania Elkhateb, Davis L. Campbell, Xinyi Zhao, Graciela Mentz, Nadir Sharawi, Sathish S. Kumar, Jill M. Mhyre, Sachin Kheterpal, Douglas A. Colquhoun · 发表于：Anesthesiology · 年份：2025 · DOI：10.1097/aln.0000000000005411 · 被引用次数：12 · 研究领域：Anesthesia and Sedative Agents、Intensive Care Unit Cognitive Disorders、Intraoperative Neuromonitoring and Anesthetic Effects

BACKGROUND: Current practice guidelines do not address the use of neuromuscular blocking and antagonism agents in patients with renal impairment. The U.S. Food and Drug Administration (Silver Spring, Maryland) label for sugammadex advises against use in patients with severe renal impairment (estimated glomerular filtration rate [eGFR] less than 30 ml/min). Using a multicenter electronic health record registry, the authors sought to understand the modern use of neuromuscular blockade and antagonism agents in patients with significant renal impairment (eGFR less than 60 ml/min). METHODS: Data were obtained from the Multicenter Perioperative Outcomes Group (MPOG) registry for adult patients (older than 18 yr) with an eGFR less than 60 ml/min, based on most recent serum creatinine, receiving general anesthesia for a nonrenal transplant procedure with an endotracheal tube between January 1, 2016, and July 31, 2022. Patients were classified into three mutually exclusive blockade and reversal strategies: rocuronium-sugammadex, cisatracurium-neostigmine, and rocuronium-neostigmine. Adjusted incidence of each blockade reversal strategy was established by a multinomial mixed effects model. The contribution of institution, anesthesiologist, and patient or case factors to variation in strategy choice was assessed by multilevel mixed effects models. RESULTS: In 243,944 cases across 5,133 anesthesiologists and 48 institutions, adjusted use of rocuronium-sugammadex increased from 4.4 to 95....