Comparison of neostigmine vs. sugammadex for recovery of muscle function after neuromuscular block by means of diaphragm ultrasonography in microlaryngeal surgery

Cappellini, Iacopo; Ostento, Daniele; Loriga, Beatrice; Tofani, Lorenzo; Gaudio, Angelo Raffaele De; Adembri, Chiara

doi:10.1097/eja.0000000000001055

Cited by 16 publications

(21 citation statements)

References 41 publications

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“…10 Sonographic and electromyography-based assessment of diaphragmatic and intercostal muscular recovery from residual neuromuscular block is more pronounced after administration of SUG vs NEO. 11,12 Several retrospective and prospective observational investigations have reported lower rates of residual neuromuscular block and respiratory complications after reversal with SUG vs NEO. 13e17 Recently, Kheterpal and colleagues 17 showed a 47% reduced rate of postoperative pneumonia after reversal with SUG vs NEO in a retrospective cohort of 45 712 patients.…”

Section: Editor's Key Pointsmentioning

confidence: 99%

Reversal of residual neuromuscular block with neostigmine or sugammadex and postoperative pulmonary complications: a prospective, randomised, double-blind trial in high-risk older patients

Ledowski

Szabó-Maák

Loh

et al. 2021

British Journal of Anaesthesia

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Background: Residual neuromuscular block is associated with an increased risk of postoperative pulmonary complications in retrospective studies. The aim of our study was to investigate prospectively the incidence of postoperative pulmonary complications after reversal with either sugammadex (SUG) or neostigmine (NEO) in high-risk older patients. Methods: We randomly allocated 180 older patients with significant morbidity (ASA physical status 3) !75 yr old to reversal of rocuronium with either SUG or NEO. Adverse events in the recovery room and pulmonary complications (defined by a 5-point [0e4; 0¼best to 4¼worst] outcome score) on postoperative Days 1, 3, and 7 were compared between groups. Results: Data from 168 patients aged 80 (4) yr were analysed; SUG vs NEO resulted in a reduced probability (0.052 vs 0.122) of increased pulmonary outcome score (impaired outcome) on postoperative Day 7, but not on Days 1 and 3. More patients in the NEO group were diagnosed with radiographically confirmed pneumonia (9.6% vs 2.4%; P¼0.046). The NEO group showed a non-significant trend towards longer hospital length of stay across all individual centres (combined 9 vs 7.5 days), with a significant difference in Malaysia (6 vs 4 days; P¼0.011). Conclusions: Reversal of rocuronium neuromuscular block with SUG resulted in a small, but possibly clinically relevant improvement in pulmonary outcome in a select cohort of high-risk older patients. Clinical trial registration: ACTRN12614000108617.

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Section: Editor's Key Pointsmentioning

confidence: 99%

Reversal of residual neuromuscular block with neostigmine or sugammadex and postoperative pulmonary complications: a prospective, randomised, double-blind trial in high-risk older patients

Ledowski

Szabó-Maák

Loh

et al. 2021

British Journal of Anaesthesia

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“…There is some, albeit very limited, evidence that NMB reversal with sugammadex may be associated with fewer PPCs than neostigmine in patients with obstructive sleep apnea [46]. Finally, Cappellini et al performed a study in patients who, after rocuronium administration, received neostigmine or sugammadex: the authors found an early (0 min) but not long-lasting (30 min) association between diaphragm failure and recovery drug treatment; a full recovery in baseline diaphragm function was observed only in patients receiving sugammadex [47]. In contrast to these favorable findings for sugammadex and PPCs, another study found no differences in pulmonary function in 130 adult patients reversed with sugammadex or neostigmine after major abdominal surgery [48].…”

Section: Are Ppcs Reduced With the Use Of Sugammadex?mentioning

confidence: 99%

Residual Neuromuscular Blockade and Postoperative Pulmonary Complications: What Does the Recent Evidence Demonstrate?

Cammu

2020

Curr Anesthesiol Rep

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Purpose of ReviewThe purpose of this review is to assess how residual neuromuscular block impacts postoperative pulmonary complications and whether we can modify the risk by improving certain aspects in daily clinical care.Recent findings Postoperative respiratory impairment may be due to various causes, such as age, surgery type, comorbidity, smoking, preoperative anemia, and general anesthesia. However, increasing evidence suggests that residual neuromuscular block is an important risk factor for postoperative pulmonary complications and may affect the outcome. Conflicting data from some recent reports show that the use of quantitative neuromuscular monitoring alone does not preclude residual neuromuscular block and that improvements in the interpretation of neuromuscular monitoring may be required. Pulmonary complications seem to be reduced for train-of-four ratios > 0.95 before tracheal extubation compared with > 0.9. Summary This review stresses the need for appropriate management of neuromuscular block in the prevention of postoperative pulmonary complications but acknowledges that the causes are multifactorial.

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“…Routine administration of sugammadex may be beneficial, however, in certain clinical situations. For example, sugammadex has been shown to efficiently reduce respiratory complications during the use of deep neuromuscular blockade [1,24] and to benefit patients undergoing relatively short surgical procedures, such as laryngeal microsurgery, when spontaneous recovery from neuromuscular is hardly expected [25,26]. A recent retrospective study also found that sugammadex was associated with reduced rates of post-thymectomy myasthenic crisis in patients with myasthenia gravis [27].…”

Section: Discussionmentioning

confidence: 99%

“…Currently, except for emergency situations, such as reversal immediately after rocuronium-induced neuromuscular blockade, and specific clinical situations [25][26][27], there are no absolute indications for the use of sugammadex. Therefore, clinical practice regarding the use of sugammadex in the absence of deep neuromuscular blockade can vary among physicians.…”

Section: Discussionmentioning

confidence: 99%

Post-operative respiratory outcomes associated with the use of sugammadex in laparoscopic colorectal cancer surgery: a retrospective, propensity score matched cohort study

2020

Signa Vitae

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Sugammadex can rapidly reverse neuromuscular blockade and has several advantages over cholinesterase inhibitors. It is unclear, however, whether administration of sugammadex in the absence of intraoperative deep neuromuscular blockade has direct clinical benefits. The present study retrospectively assessed the ability of sugammadex to prevent post-operative respiratory adverse events in patients undergoing laparoscopic colorectal surgery in the absence of routine deep neuromuscular blockade. The medical records of patients who underwent laparoscopic colorectal surgery from 2014 to 2018 in a tertiary care hospital were reviewed. Patients who underwent reversal of neuromuscular blockade with sugammadex or pyridostigmine were subjected to propensity score matching. To assess their relative effects on post-operative adverse respiratory events (defined as a composite of SpO2 < 94% in the post-anesthesia care unit, additional oxygen supplementation during ward transfer or stay, and emergency use of sugammadex in the post-anesthesia care unit), the incidence of these effects was compared in propensity score matched groups of patients treated with sugammadex or pyridostigmine. Of the 602 patients, 210 remained in each group after propensity score matching. The incidence of post-operative respiratory adverse events did not differ significantly in the two groups. These findings suggest that the unrestricted administration of sugammadex not preceded by intra-operative deep neuromuscular blockade does not have clinical benefits, when compared with pyridostigmine, in preventing post-operative respiratory adverse events.

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Comparison of neostigmine vs. sugammadex for recovery of muscle function after neuromuscular block by means of diaphragm ultrasonography in microlaryngeal surgery

Cited by 16 publications

References 41 publications

Reversal of residual neuromuscular block with neostigmine or sugammadex and postoperative pulmonary complications: a prospective, randomised, double-blind trial in high-risk older patients

Reversal of residual neuromuscular block with neostigmine or sugammadex and postoperative pulmonary complications: a prospective, randomised, double-blind trial in high-risk older patients

Residual Neuromuscular Blockade and Postoperative Pulmonary Complications: What Does the Recent Evidence Demonstrate?

Post-operative respiratory outcomes associated with the use of sugammadex in laparoscopic colorectal cancer surgery: a retrospective, propensity score matched cohort study

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