Background There is a growing interest in minimally invasive left atrial appendage closure therapies. However, for successful catheter surgery, it is necessary to achieve high-quality postoperative recovery. The aim of the study is to comparison of neuromuscular blockade and reversal using cisatricurium and neostigmine with rocuronium and sugamadex on the quality of recovery from general anaesthesia for percutaneous closure of left atria appendage. Methods Eighty-four patients who received percutaneous LAAC were randomly placed into two groups, general anesthesia and endotracheal intubation with either propofol-remifentanil-cisatracurium-neostigmine (group C) or propofol-remifentanil-rocuronium-sugammadex (group S). The QoR-40 questionnaire was used to assess recovery quality 6 h after surgery, and the time of spontaneous respiration, the time of consciousness recovery, the time of extubation, the duration in the postanaesthesia care unit (PACU), and the adverse events after awakening were collected. Results Compared with the group C, the group S demonstrated significantly higher individual QoR-40 dimension scores, a significantly shorter recovery time for spontaneous respiration and consciousness, time of extubation, and duration in the PACU, and a lower incidence of transient hypoxemia, agitation, nausea and vomiting and urinary retention. There was a non-significant trend for the length of stay in the hospital in both groups. Conclusions General anesthesia and endotracheal intubation with propofol-remifentanil-rocuronium-sugammadex provided better quality of recovery, shorter anaesthesia duration, and lower incidence of hypoxemia and agitation. Neuromuscular blockade and reversal using rocuronium and sugamadex is better than with cisatricurium and neostigmine on the quality of recovery from general anaesthesia for percutaneous closure of left atria appendage. Trial registration: chictr.org, ChiCTR2000031857. Registered on April 12, 2020.

IntroductionIncomplete reversal of neuromuscular blocking drugs can delay patients' rapid recovery and lead to adverse events in the postoperative period, especially in high-risk patients. Sugammadex as a reversal agent, may offer distinct advantages to the scenario where residual neuromuscular blockade may be poorly tolerated. We aimed to investigate the efficacy of sugammadex compared with neostigmine on perioperative outcomes in patients with preoperative tracheal stenosis undergoing rigid bronchoscopy.MethodWe conducted a retrospective cohort study of adults who were diagnosed with primary or secondary tracheobronchial stenosis, and scheduled for interventional therapy under rigid bronchoscopy, at Shanghai Chest Hospital between December 2016 and July 2020. The exposure was categorized into two groups according to the antagonists of muscle relaxants administered after surgery: Group neostigmine vs. Group sugammadex. The primary outcome was the time to extubate after surgery, and the second outcome was the time to discharge from PACU. Perioperative adverse events were recorded.ResultsA total of 98 patients undergoing rigid bronchoscopy procedures were included. Patients in Group sugammadex showed less time to extubate (11 [8, 17] vs. 16 [12, 22] min, P = 0.003) and discharge from PACU (27 [20, 33] vs. 32.5 [24, 44] min, P = 0.013) than in Group neostigmine. The incidence and duration of hypotension during the procedure in Group sugammadex were significantly lower than that in Group neostigmine (18.5 vs. 40.8%, P = 0.038; 0 [0, 0] vs. 0 [0, 8] min, P = 0.036 respectively).ConclusionsSugammadex shortens the time to extubate and discharge from PACU in patients with tracheobronchial stenosis, accelerating postoperative recovery.