{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T22:10:49Z","timestamp":1790892649321,"version":"4.1.0"},"reference-count":25,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2022,5,1]],"date-time":"2022-05-01T00:00:00Z","timestamp":1651363200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2022,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The prevalence and risk factors for residual neuromuscular blockade in children remain poorly characterized. We hypothesize that specific patient and anesthetic risk factors may be associated with the administration of additional reversal in children following initial reversal of rocuronium with neostigmine.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Our electronic health record was queried for patients &lt;18\u2009years of age who received rocuronium and reversal with neostigmine from 2017 through 2020. Patients receiving other nondepolarizing neuromuscular blocking drugs were excluded. The outcome of interest was defined as the administration of additional neostigmine or sugammadex following primary reversal with neostigmine. Time between the last dose of rocuronium and initial dose of neostigmine, and the cumulative dose of rocuronium were dichotomized. These were combined with other covariates including age, weight, sex, racial group, procedure type, ASA physical status, &gt;1 rocuronium dose administered during the procedure, initial neostigmine dose &lt;0.05\u2009mg\u2009kg<jats:sup>\u22121<\/jats:sup>, use of train\u2010of\u2010four monitoring, duration of anesthesia, inpatient or outpatient, emergency case, neuromuscular disease, and extremes of weight, to assess possible associations with the primary outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During the study period, 101\/6373 (1.58%) patients received rocuronium and additional reversal. Dichotomization of time between last dose of rocuronium and neostigmine yielded &lt;28\u00a0min since the last dose of rocuronium and cumulative dose of rocuronium &gt;0.45\u00a0mg\u00a0kg<jats:sup>\u22121<\/jats:sup>\u2009hr<jats:sup>\u22121<\/jats:sup>. These were associated with the administration of additional reversal with an OR 1.52 (95% CI, 1.08\u20132.35) and OR 1.71 (95% CI, 1.10\u20132.67), respectively. Other risk factors included an initial neostigmine dose &lt;0.05\u2009mg\u2009kg<jats:sup>\u22121<\/jats:sup>, OR 4.98 (95% CI, 2.84\u20136.49), and African American race, OR 1.78 (95% CI, 1.07\u20132.87).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Risk factors associated with the administration of additional reversal included time &lt;28\u2009min from the last dose of rocuronium to initial dose of neostigmine, cumulative dose of rocuronium &gt;0.45\u2009mg\u2009kg<jats:sup>\u22121<\/jats:sup>\u2009hr<jats:sup>\u22121<\/jats:sup>, initial neostigmine dose &lt;0.05\u2009mg\u2009kg<jats:sup>\u22121<\/jats:sup>, and African American race.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.14463","type":"journal-article","created":{"date-parts":[[2022,4,19]],"date-time":"2022-04-19T16:38:37Z","timestamp":1650386317000},"page":"916-925","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Risk factors for administration of additional reversal following neuromuscular blockade with rocuronium in children: A retrospective <scp>case\u2013control<\/scp> study"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8823-5773","authenticated-orcid":false,"given":"Susan R.","family":"Vishneski","sequence":"first","affiliation":[{"name":"Department of Anesthesiology Wake Forest School of Medicine  Winston\u2010Salem North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amit K.","family":"Saha","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Wake Forest School of Medicine  Winston\u2010Salem North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madeline R.","family":"Fram","sequence":"additional","affiliation":[{"name":"Wake Forest School of Medicine  Winston\u2010Salem North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7307-2169","authenticated-orcid":false,"given":"Leah B.","family":"Templeton","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Wake Forest School of Medicine  Winston\u2010Salem North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa K.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology UCLA  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas G.","family":"Ririe","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Wake Forest School of Medicine  Winston\u2010Salem North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3479-7180","authenticated-orcid":false,"given":"Eduardo Javier","family":"Goenaga\u2010Diaz","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Wake Forest School of Medicine  Winston\u2010Salem North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5806-9236","authenticated-orcid":false,"given":"Laura Daniela","family":"Smith","sequence":"additional","affiliation":[{"name":"Wake Forest School of Medicine  Winston\u2010Salem North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7665-8138","authenticated-orcid":false,"given":"Thomas Wesley","family":"Templeton","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Wake Forest School of Medicine  Winston\u2010Salem North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,5]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000003256"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e6329"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000001279"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1213\/00000539-199104000-00015"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2018.10.001"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1155\/2015\/410248"},{"key":"e_1_2_9_8_1","unstructured":"BloxiverzHighlights of prescribing information.https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2013\/204078s000lbl.pdf. 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