Sugammadex is associated with enhanced postoperative extubation of pediatric patients with Duchenne muscular dystrophy and spinal muscular atrophy after scoliosis surgeries

Abstract

Perioperative management in patients with muscular dystrophy is challenging due to heightened sensitivity to nondepolarizing neuromuscular blocking agents, which can prolong intubation and hospital stay. This study evaluated whether sugammadex could safely reverse rocuronium-induced neuromuscular block and thereby shorten extubation and postoperative recovery in pediatric patients with Duchenne muscular dystrophy (DMD) or spinal muscular atrophy (SMA) undergoing scoliosis surgery. We retrospectively reviewed 23 surgical procedures in 17 patients at a tertiary referral center between August 2013 and December 2018. Patients receiving sugammadex (group S, n  = 10) were compared with those not given reversal agents (group N, n  = 13). Extubation in the operating room was achieved in 80% of group S patients and in none of the group N patients. In the subgroup undergoing posterior correction surgery, sugammadex reduced hospital length of stay by a mean of 4.6 days (13.2 vs. 8.6 days; 95% CI − 7.11 to − 2.48, P  < 0.001). Two patients in group N experienced postoperative respiratory complications, whereas no complications occurred in group S. Sugammadex group appeared to show earlier extubation and enhanced recovery in pediatric patients with DMD or SMA undergoing scoliosis surgery. Its use was associated with shorter hospital stays and fewer respiratory complications, particularly in patients undergoing posterior correction. These findings support sugammadex as a safe and effective reversal agent in this high-risk population and suggest it improves restoring muscle function after the use of rocuronium-induced neuromuscular block in patients with musculoskeletal disorders, thus effectively reducing the time required for postoperative artificial ventilation support.