The Safety of Neuromuscular Blockade Reversal in Patients with Cardiac Transplantation

David W. Barbara, Jon M. Christensen, William J. Mauermann, Joseph A. Dearani, Joseph A. Hyder

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background Neuromuscular blockade (NMB) reversal with neostigmine and glycopyrrolate has been reported to cause cardiac arrest in patients with a history of cardiac transplantation. The purpose of this study was to examine the safety of NMB reversal with acetylcholinesterase inhibitors and muscarinic anticholinergics in these patients. Methods We queried the medical records of a large tertiary referral center for patients with a history of prior heart transplantation who underwent anesthesia including receipt of NMB reversal. Patient records were reviewed to investigate maximal decrease in heart rate (HR) after NMB reversal and incidence of death and cardiac arrest. Results Seventy-seven heart transplant patients underwent 118 subsequent anesthetics during which they received neostigmine and glycopyrrolate for NMB reversal. No patients had active pacemakers at the time of their anesthetics. Mean time from heart transplantation to NMB reversal was 2.9 ± 3.2 (median, 1.9; range, 0.01- 12.5) years. After NMB reversal, no patients received atropine or epinephrine, suffered cardiac arrest, or died within 30 days. Mean HR decrease, defined as the difference between the HR immediately before NMB reversal and the lowest HR within 5 minutes thereafter, after NMB reversal was 0.5 ± 3.2 with median 0 (range, -8 to 17) beats per minute. Mean HR decrease was not associated with transplantation type (biatrial versus bicaval, P = 0.2029) or with increasing duration of time from cardiac transplantation (P = 0.0874). Conclusions Although rare cases of cardiac arrest after NMB reversal have been reported, our experience would support the safety of neostigmine and glycopyrrolate in cardiac transplantation patients.

Original languageEnglish (US)
Pages (from-to)2723-2728
Number of pages6
JournalTransplantation
Volume100
Issue number12
DOIs
StatePublished - Dec 1 2016

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Neuromuscular Blockade
Heart Transplantation
Safety
Glycopyrrolate
Heart Arrest
Neostigmine
Heart Rate
Anesthetics
Cholinesterase Inhibitors
Cholinergic Antagonists
Atropine
Tertiary Care Centers
Cholinergic Agents
Epinephrine
Medical Records
Anesthesia
Transplantation
Transplants

ASJC Scopus subject areas

  • Transplantation

Cite this

Barbara, D. W., Christensen, J. M., Mauermann, W. J., Dearani, J. A., & Hyder, J. A. (2016). The Safety of Neuromuscular Blockade Reversal in Patients with Cardiac Transplantation. Transplantation, 100(12), 2723-2728. https://doi.org/10.1097/TP.0000000000001060

The Safety of Neuromuscular Blockade Reversal in Patients with Cardiac Transplantation. / Barbara, David W.; Christensen, Jon M.; Mauermann, William J.; Dearani, Joseph A.; Hyder, Joseph A.

In: Transplantation, Vol. 100, No. 12, 01.12.2016, p. 2723-2728.

Research output: Contribution to journalArticle

Barbara, DW, Christensen, JM, Mauermann, WJ, Dearani, JA & Hyder, JA 2016, 'The Safety of Neuromuscular Blockade Reversal in Patients with Cardiac Transplantation', Transplantation, vol. 100, no. 12, pp. 2723-2728. https://doi.org/10.1097/TP.0000000000001060
Barbara DW, Christensen JM, Mauermann WJ, Dearani JA, Hyder JA. The Safety of Neuromuscular Blockade Reversal in Patients with Cardiac Transplantation. Transplantation. 2016 Dec 1;100(12):2723-2728. https://doi.org/10.1097/TP.0000000000001060
Barbara, David W. ; Christensen, Jon M. ; Mauermann, William J. ; Dearani, Joseph A. ; Hyder, Joseph A. / The Safety of Neuromuscular Blockade Reversal in Patients with Cardiac Transplantation. In: Transplantation. 2016 ; Vol. 100, No. 12. pp. 2723-2728.
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