Efficacy and safety of sugammadex in patients undergoing renal transplantation.

BACKGROUND: Sugammadex reverses rocuronium by encapsulating it, creating a stable complex that is mainly excreted by the kidneys. Nonetheless, in view of exposure to sugammadex during renal transplantation, current safety data are insufficient. We retrospectively investigated the safety and efficacy of sugammadex in the immediate perioperative period and over long-term follow-up. CASE PRESENTATION: We studied 99 consecutive patients who underwent living renal transplantation. We investigated the efficacy of sugammadex and its perioperative complications in the first 48-72 h in the surgical intensive care unit and in the follow-up for 6 months. Before transplantation, 53 patients required hemodialysis. The median serum creatinine concentration was 5.6 mg/dl, and blood urea nitrogen (BUN) was 30 mg/dl. During surgery, the median rocuronium and sugammadex dose was 160 mg (interquartile range 130-185 mg) and 200 mg (200-200 mg), respectively. After transplantation, the median serum creatinine concentration was 2.4 mg/dl at postoperative day 1, and BUN was 21 mg/dl, respectively. No adverse events were recorded during the observation period. CONCLUSION: We investigated whether 99 consecutive patients undergoing renal transplantation may benefit from the use of sugammadex. There were no adverse events. We concluded that, in our observational period, sugammadex was efficacious and safe in patients who underwent renal transplantation.

Tissue oxygenation index reflects changes in forearm blood flow after brief ischemia.

Whether the near-infrared spectroscopy (NIRS) technology correctly detects the changes in oxygenation related to ischemia and reperfusion of organs and tissues other than brain remains unclear. The present study examined how different tissue oxygenation parameters derived from NIRS reflect the changes in the forearm blood flow (FBF) according to the brief ischemia and the subsequent reperfusion, and whether values of these parameters move in parallel with the medial and lateral sides of FBF. Thirteen volunteers underwent the prospective observational study. The tissue oxygenation index (TOI), regional saturation of oxygen (rSO2), skin tissue oxygenation (StO2), and FBF values were evaluated in the forearm. Medial rSO2 values at 1 to 3 minutes after the termination of brief ischemia were higher than lateral rSO2 and respective TOI values. FBF and StO2 values quickly increased according to the cessation of brief ischemia, whereas the medial and lateral values did not differ during and after the brief ischemia. TOI and StO2, but not rSO2, reflected changes in FBF of both medial and lateral sides simultaneously in response to the reperfusion after brief ischemia. The muscle tissue oxygenation during reperfusion favors the use of TOI and StO2, but not rSO2, as the surrogate parameter. J. Med. Invest. 64: 228-232, August, 2017.