{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T09:23:48Z","timestamp":1762161828501,"version":"3.44.0"},"reference-count":15,"publisher":"The Pediatric Pharmacy Association","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023]]},"abstract":"<jats:p>The neuromuscular blocking drugs rocuronium and vecuronium are often used during general anesthesia. These drugs temporarily paralyze the patient and thus both facilitate placement of an endotracheal tube and prevent any patient movement during surgery. Reversal of neuromuscular blockade is necessary at the end of surgery to avoid postoperative weakness and adverse respiratory events in the recovery room. Neostigmine, the traditional reversal agent, may not completely restore muscle strength. Sugammadex is a reversal agent that is more effective and quicker acting than neostigmine. In adults, sugammadex administration has rarely been associated with bradycardia and cardiac arrest. In healthy children, the bradycardia that occurs after sugammadex administration is benign and does not require intervention. There is 1 case report of a 10- to 15-second bradycardic arrest after sugammadex administration to a 10-year-old child with heart disease. The present case report describes an 8-month-old child with complex congenital heart disease who experienced a 10-minute bradycardic arrest after the administration of sugammadex. Pediatric anesthesiologists should be aware that sugammadex administration to children with heart disease may cause hemodynamically significant bradycardia.<\/jats:p>","DOI":"10.5863\/1551-6776-28.7.667","type":"journal-article","created":{"date-parts":[[2023,11,28]],"date-time":"2023-11-28T08:59:08Z","timestamp":1701161948000},"page":"667-670","source":"Crossref","is-referenced-by-count":5,"title":["Bradycardic Arrest in a Child with Complex Congenital Heart Disease Due to Sugammadex Administration"],"prefix":"10.5863","volume":"28","author":[{"given":"Zameer G.","family":"Vaswani","sequence":"first","affiliation":[{"name":"Dell Medical School (ZGV), University of Texas, Austin, TX"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah M.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Surgery and Perioperative Care (SMS, AZ, EAG, PWS), Dell Medical School, University of Texas, Austin, TX; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony","family":"Zapata","sequence":"additional","affiliation":[{"name":"Department of Surgery and Perioperative Care (SMS, AZ, EAG, PWS), Dell Medical School, University of Texas, Austin, TX; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erin A.","family":"Gottlieb","sequence":"additional","affiliation":[{"name":"Department of Surgery and Perioperative Care (SMS, AZ, EAG, PWS), Dell Medical School, University of Texas, Austin, TX; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul W.","family":"Sheeran","sequence":"additional","affiliation":[{"name":"Department of Surgery and Perioperative Care (SMS, AZ, EAG, PWS), Dell Medical School, University of Texas, Austin, TX; and"},{"name":"Department of Pediatrics (PWS), Dell Medical School, University of Texas, Austin, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"3883","reference":[{"key":"i2331-348X-28-7-667-b1","series-title":"Core Evid","first-page":"57","article-title":"Sugammadex as a reversal agent for neuromuscular block: an evidence-based review","volume":"8","author":"Schaller","year":"2013","unstructured":"Schaller\n              SJ\n            , FinkH. Sugammadex as a reversal agent for neuromuscular block: an evidence-based review. Core Evid. 2013;8:57\u201367."},{"key":"i2331-348X-28-7-667-b2","series-title":"J Clin Anesth","first-page":"109818","article-title":"Incidence of residual neuromuscular blockade and use of neuromuscular blocking agents with or without antagonists: a systematic review and meta-analysis of randomized controlled trials","volume":"64","author":"Raval","year":"2020","unstructured":"Raval\n              A\n            , UyeiJ, KarabisA,\n          . Incidence of residual neuromuscular blockade and use of neuromuscular blocking agents with or without antagonists: a systematic review and meta-analysis of randomized controlled trials. J Clin Anesth. 2020;64:109818."},{"issue":"(8)","key":"i2331-348X-28-7-667-b3","series-title":"Cochrane Database Syst Rev","first-page":"CD012763","article-title":"Efficacy and safety of sugammadex versus neostigmine in reversing neuromuscular blockade in adults","volume":"8","author":"Hristovska","year":"2017","unstructured":"Hristovska\n              A\n            , DuchP, AllingstrupM, AfshariA. Efficacy and safety of sugammadex versus neostigmine in reversing neuromuscular blockade in adults. Cochrane Database Syst Rev. 2017;8(8):CD012763."},{"key":"i2331-348X-28-7-667-b4","series-title":"Anesth Analg","first-page":"1518","article-title":"A Survey of the Society for Pediatric Anesthesia on the use, monitoring, and antagonism of neuromuscular blockade","volume":"132","author":"Faulk","year":"2021","unstructured":"Faulk\n              DJ\n            , AustinTM, ThomasJJ,\n          . A Survey of the Society for Pediatric Anesthesia on the use, monitoring, and antagonism of neuromuscular blockade. Anesth Analg. 2021;132:1518\u20131526."},{"issue":"(1)","key":"i2331-348X-28-7-667-b5","series-title":"Medicina (Kansas)","first-page":"79","article-title":"Severe hypotension, bradycardia and asystole after sugammadex administration in an elderly patient","volume":"57","author":"Fierro","year":"2021","unstructured":"Fierro\n              C\n            , MedoroA, MignognaD,\n          . Severe hypotension, bradycardia and asystole after sugammadex administration in an elderly patient. Medicina (Kansas). 2021;57(1):79."},{"issue":"(1)","key":"i2331-348X-28-7-667-b6","series-title":"Br J Anaesth","first-page":"95","article-title":"Severe bradycardia and asystole after sugammadex","volume":"121","author":"Bhavani","year":"2018","unstructured":"Bhavani\n              S\n            \n          . Severe bradycardia and asystole after sugammadex. Br J Anaesth. 2018;121(1):95\u2013106."},{"key":"i2331-348X-28-7-667-b7","series-title":"A A Pract","first-page":"22","article-title":"Profound bradycardia and cardiac arrest after sugammadex administration in a previously healthy patient: a case report","volume":"12","author":"Sanoja","year":"2019","unstructured":"Sanoja\n              I\n            , TothK. Profound bradycardia and cardiac arrest after sugammadex administration in a previously healthy patient: a case report. A A Pract. 2019;12:22\u201324."},{"issue":"(2)","key":"i2331-348X-28-7-667-b8","series-title":"J Anesth","first-page":"238","article-title":"Heart rate changes following the administration of sugammadex in children: a prospective, observational study","volume":"34","author":"Alsuhebani","year":"2020","unstructured":"Alsuhebani\n              M\n            , SimsT, HansenJK,\n          . Heart rate changes following the administration of sugammadex in children: a prospective, observational study. J Anesth. 2020;34(2):238\u2013242."},{"issue":"(5)","key":"i2331-348X-28-7-667-b9","series-title":"J Pediatr Pharmacol Ther","first-page":"378","article-title":"Bradycardia in a pediatric heart transplant recipient: is it the sugammadex?","volume":"22","author":"King","year":"2017","unstructured":"King\n              A\n            , NaguibA, TobiasJD. Bradycardia in a pediatric heart transplant recipient: is it the sugammadex?J Pediatr Pharmacol Ther. 2017;22(5):378\u2013381."},{"issue":"(5)","key":"i2331-348X-28-7-667-b10","series-title":"Cardiol Res","first-page":"274","article-title":"Heart rate changes following the administration of sugammadex to infants and children with comorbid cardiac, cardiovascular, and congenital heart diseases","volume":"11","author":"Arends","year":"2020","unstructured":"Arends\n              J\n            , HubbardR, ShafySZ,\n          . Heart rate changes following the administration of sugammadex to infants and children with comorbid cardiac, cardiovascular, and congenital heart diseases. Cardiol Res. 2020;11(5):274\u2013279."},{"issue":"(1)","key":"i2331-348X-28-7-667-b11","series-title":"Braz J Anesthesiol","first-page":"101","article-title":"Bradycardia in a pediatric population after sugammadex administration: case series","volume":"73","author":"Carvalho","year":"2023","unstructured":"Carvalho\n              EV\n            , CaldasAM, da CostaDF,\n          . Bradycardia in a pediatric population after sugammadex administration: case series. Braz J Anesthesiol. 2023 Jan-Feb; 73(1):101-103."},{"issue":"(2)","key":"i2331-348X-28-7-667-b12","series-title":"Clin Pharmacol Ther","first-page":"239","article-title":"A method for estimating the probability of adverse drug reactions","volume":"30","author":"Naranjo","year":"1981","unstructured":"Naranjo\n              CA\n            , BustoU, SellersEM,\n          . A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30(2):239\u2013245."},{"year":"June 2021","key":"i2331-348X-28-7-667-b13","unstructured":"Bridion (sugammadex) injection, for intravenous use. Revised June 2021. https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2015\/022225lbl.pdf"},{"key":"i2331-348X-28-7-667-b14","series-title":"BMC Pediatr","first-page":"295","article-title":"Efficacy and safety of sugammadex for neuromuscular blockade reversal in pediatric patients: an updated meta-analysis of randomized controlled trials with trial sequential analysis","volume":"22","author":"Lang","year":"2022","unstructured":"Lang\n              B\n            , HanL, ZengL,\n          . Efficacy and safety of sugammadex for neuromuscular blockade reversal in pediatric patients: an updated meta-analysis of randomized controlled trials with trial sequential analysis. BMC Pediatr. 2022;22:295."},{"issue":"(1)","key":"i2331-348X-28-7-667-b15","series-title":"Br J Anaesth","first-page":"8","article-title":"Sugammadex-induced bradycardia and asystole: how great is the risk?","volume":"121","author":"Hunter","year":"2018","unstructured":"Hunter\n              JM\n            , NaguibM. Sugammadex-induced bradycardia and asystole: how great is the risk?Br J Anaesth. 2018;121(1):8\u201312."}],"container-title":["The Journal of Pediatric Pharmacology and Therapeutics"],"original-title":[],"link":[{"URL":"https:\/\/jppt.kglmeridian.com\/view\/journals\/jppt\/28\/7\/article-p667.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/meridian.allenpress.com\/jppt\/article-pdf\/28\/7\/667\/3292984\/i2331-348x-28-7-667.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/jppt.kglmeridian.com\/downloadpdf\/journals\/jppt\/28\/7\/article-p667.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/jppt.kglmeridian.com\/downloadpdf\/journals\/jppt\/28\/7\/article-p667.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,16]],"date-time":"2025-05-16T00:49:03Z","timestamp":1747356543000},"score":1,"resource":{"primary":{"URL":"https:\/\/jppt.kglmeridian.com\/view\/journals\/jppt\/28\/7\/article-p667.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023]]},"references-count":15,"journal-issue":{"issue":"7"},"URL":"https:\/\/doi.org\/10.5863\/1551-6776-28.7.667","relation":{},"ISSN":["2331-348X","1551-6776"],"issn-type":[{"type":"electronic","value":"2331-348X"},{"type":"print","value":"1551-6776"}],"subject":[],"published":{"date-parts":[[2023]]}}}