Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://cr.elmerpub.com

Original Article

Volume 17, Number 4, August 2026, pages 300-307

Sugammadex: Safety Profile and Adverse Effects in Infants Less Than Two Years of Age With Congenital Heart Disease

↓ Figure 1. Rates of successful tracheal extubation, residual neuromuscular blockade, and adverse events by reversal agent. There was no statistically significant difference between any of the three outcomes when comparing sugammadex with neostigmine. Please see Table 2 and its footnote for a list of adverse effects. As this was a retrospective review, the temporal and causal association with sugammadex could not be determined

↓ **Table 1.** Demographic and Clinical Characteristics of Study Population^a
Characteristics	Overall	Neostigmine	Sugammadex	P value
Data are presented as counts and percentages for categorical variables and as median (IQR) for continuous variables. ^aAll data are reported per encounters. P values were calculated using Pearson’s Chi-square test or Fisher’s exact test, as appropriate, for categorical variables and Wilcoxon rank-sum test for continuous variables. ASA: American Society of Anesthesiologists.
Study population, n (%)	497	139 (28.0)	358 (72.0)
Age (months)	7 (3,12)	6 (4,12)	7 (3,13)	0.73
Sex				0.88
Female	228 (45.9)	63 (45.3)	165 (46.1)
Male	269 (54.1)	76 (54.7)	193 (53.9)
Height (cm)	65 (58,73)	65 (57,73.3)	65 (58,73)	0.73
Weight (kg)	6.6 (5.1,8.8)	6.6 (5.1,9.3)	6.6 (5,8.7)	0.39
ASA classification				< 0.01
2	14 (2.8)	9 (6.5)	5 (1.4)
≥ 3	483 (97.2)	130 (93.5)	353 (98.6)
Surgical procedure				0.37
Cardiac catheterization	267 (53.9)	81 (58.7)	186 (52.1)
Cardiopulmonary bypass	104 (21.0)	22 (15.9)	82 (23.0)
Non-cardiac	15 (3.0)	4 (2.9)	11 (3.1)
Other cardiac	109 (22.0)	31 (22.5)	78 (21.8)
Total anesthesia time (min)	268.7 (214.1, 327.7)	253.4 (185.7, 314.6)	275.3 (218.5, 334.2)	0.01
Total procedure time (min)	174.8 (135.4, 222.8)	174.8 (128.9, 225)	172.6 (137.6, 220.6)	0.97

↓ Table 1. Demographic and Clinical Characteristics of Study Population^a

Characteristics

Overall

Neostigmine

Sugammadex

P value

Data are presented as counts and percentages for categorical variables and as median (IQR) for continuous variables. ^aAll data are reported per encounters. P values were calculated using Pearson’s Chi-square test or Fisher’s exact test, as appropriate, for categorical variables and Wilcoxon rank-sum test for continuous variables. ASA: American Society of Anesthesiologists.

Study population, n (%)

497

139 (28.0)

358 (72.0)

Age (months)

7 (3,12)

6 (4,12)

7 (3,13)

0.73

Sex

0.88

Female

228 (45.9)

63 (45.3)

165 (46.1)

Male

269 (54.1)

76 (54.7)

193 (53.9)

Height (cm)

65 (58,73)

65 (57,73.3)

65 (58,73)

0.73

Weight (kg)

6.6 (5.1,8.8)

6.6 (5.1,9.3)

6.6 (5,8.7)

0.39

ASA classification

< 0.01

14 (2.8)

9 (6.5)

5 (1.4)

≥ 3

483 (97.2)

130 (93.5)

353 (98.6)

Surgical procedure

0.37

Cardiac catheterization

267 (53.9)

81 (58.7)

186 (52.1)

Cardiopulmonary bypass

104 (21.0)

22 (15.9)

82 (23.0)

Non-cardiac

15 (3.0)

4 (2.9)

11 (3.1)

Other cardiac

109 (22.0)

31 (22.5)

78 (21.8)

Total anesthesia time (min)

268.7 (214.1, 327.7)

253.4 (185.7, 314.6)

275.3 (218.5, 334.2)

0.01

Total procedure time (min)

174.8 (135.4, 222.8)

174.8 (128.9, 225)

172.6 (137.6, 220.6)

0.97

↓ **Table 2.** Measures of Efficacy and Adverse Effects
Characteristics	Overall	Neostigmine	Sugammadex	P value
Data are presented as counts and percentages. P values were calculated using Pearson’s Chi-square test or Fisher’s exact test, as appropriate. For statistical testing, adverse effect was analyzed as a binary variable (any vs none). Other adverse effects included respiratory dysfunction (postoperative respiratory insufficiency, hypoxemia, cough, increased work of breathing, stridor, congestion, hypoventilation, laryngospasm, hypercapnia, respiratory arrest, pleural effusion); hemodynamic concerns (arrythmias, hypotension, hypertension, decreased perfusion, increased lactate, tachycardia, heart block, bradycardia, altered peripheral pulses); central nervous system (delirium, agitation, decreased mental status, seizure activity, sedation); and miscellaneous issues (hyperglycemia, emesis, postoperative hemorrhage). As this was a retrospective review, the temporal and causal association with sugammadex could not be determined.
Study encounter, n (%)	497	139 (28.0)	358 (72.0)
Successful tracheal extubation				0.70
No	46 (9.3)	14 (10.1)	32 (8.9)
Yes	451 (90.7)	125 (89.9)	326 (91.1)
Residual neuromuscular blockade				1.00
No	488 (98.2)	137 (98.6)	351 (98.0)
Yes	9 (1.8)	2 (1.4)	7 (2.0)
Adverse effect				0.47
None	362 (72.8)	98 (70.5)	264 (73.7)
Bradycardia	7 (1.4)	2 (1.4)	5 (1.4)
Other	128 (25.8)	39 (28.1)	89 (24.9)

↓ Table 2. Measures of Efficacy and Adverse Effects

Characteristics

Overall

Neostigmine

Sugammadex

P value

Data are presented as counts and percentages. P values were calculated using Pearson’s Chi-square test or Fisher’s exact test, as appropriate. For statistical testing, adverse effect was analyzed as a binary variable (any vs none). Other adverse effects included respiratory dysfunction (postoperative respiratory insufficiency, hypoxemia, cough, increased work of breathing, stridor, congestion, hypoventilation, laryngospasm, hypercapnia, respiratory arrest, pleural effusion); hemodynamic concerns (arrythmias, hypotension, hypertension, decreased perfusion, increased lactate, tachycardia, heart block, bradycardia, altered peripheral pulses); central nervous system (delirium, agitation, decreased mental status, seizure activity, sedation); and miscellaneous issues (hyperglycemia, emesis, postoperative hemorrhage). As this was a retrospective review, the temporal and causal association with sugammadex could not be determined.

Study encounter, n (%)

497

139 (28.0)

358 (72.0)

Successful tracheal extubation

0.70

46 (9.3)

14 (10.1)

32 (8.9)

Yes

451 (90.7)

125 (89.9)

326 (91.1)

Residual neuromuscular blockade

1.00

488 (98.2)

137 (98.6)

351 (98.0)

Yes

9 (1.8)

2 (1.4)

7 (2.0)

Adverse effect

0.47

None

362 (72.8)

98 (70.5)

264 (73.7)

Bradycardia

7 (1.4)

2 (1.4)

5 (1.4)

Other

128 (25.8)

39 (28.1)

89 (24.9)