Effects of Sugammadex on Post-Operative Pulmonary Complications in Laparoscopic Gastrectomy: A Retrospective Cohort Study

Abstract

The use of sugammadex can reduce post-operative residual neuromuscular blockade, which is known to increase the risk of post-operative respiratory events. However, its effect on post-operative pulmonary complications is not obvious. This study was performed to evaluate the effects of sugammadex on post-operative pulmonary complications in patients undergoing laparoscopic gastrectomy between 2013 and 2017. We performed propensity score matching to correct for selection bias. Post-operative pulmonary complications (i.e., pneumonia, respiratory failure, pleural effusion, atelectasis, pneumothorax, and aspiration pneumonitis) were evaluated from the radiological and laboratory findings. We also evaluated admission to the intensive care unit after surgery, re-admission or an emergency room visit within 30 days after discharge, length of hospital stay, re-operation, and mortality within 90 days post-operatively as secondary outcomes. In the initial cohort of 3802 patients, 541 patients were excluded, and 1232 patients were analyzed after propensity score matching. In the matched cohort, pleural effusion was significantly reduced in the sugammadex group compared to the neostigmine group (neostigmine 23.4% vs. sugammadex 18%, p = 0.02). Other pulmonary complications and secondary outcomes were not significantly different between the groups. In comparison to neostigmine, the use of sugammadex was associated with a lower incidence of post-operative pleural effusion in laparoscopic gastrectomy.

Postoperative Pulmonary Complications’ Association with Sugammadex versus Neostigmine: A Retrospective Registry Analysis

“…Although sugammadex is well known for its use in reducing the risk of postoperative residual neuromuscular blockade in well-controlled studies, this has not always improved clinical measures of postoperative strength and has not always reduced postoperative pulmonary complications. 42,43 In daily clinical practice, the data regarding its impact on postoperative pulmonary complications have been mixed. 44 We observed a lower absolute incidence rate of postoperative pulmonary complications over time; however, we were simply unable to distinguish that from background improvements that we observed in our cohort.…”

Comparison Effects of two Muscle Relaxant Strategies on Postoperative Pulmonary Complications in Transapical Transcatheter Aortic Valve Implantation: A Propensity Score-Matched Analysis

“…Sugammadex can quickly and e ciently re-establish normal muscle strength and cause less postoperative pleural effusion rate after TA-TAVI procedure. This nding was reinforced from a retrospective observational study by Han et al (17). They found that the postoperative pleural effusion rate was lower in patients receiving sugammadex when compared to patients receiving neostigmine, although they failed to found a signi cant difference of the incidence of PPCs between the groups (17).…”

“…This nding was reinforced from a retrospective observational study by Han et al (17). They found that the postoperative pleural effusion rate was lower in patients receiving sugammadex when compared to patients receiving neostigmine, although they failed to found a signi cant difference of the incidence of PPCs between the groups (17). Furthermore, previous study showed that neostigmine can adversely affect neuromuscular function and impair muscle function (genioglossus muscle and diaphragm) which was associated with respiratory complications (37,38).…”

“…Previous meta-analyses have shown that sugammadex reversed NMB more rapidly than neostigmine and was associated with fewer residual NMB rate (TOF ratio of less than 0.9) (30,31). However, prior observational(16, 18, 32) and randomized trials (15,17,33) have reported con icting results on the effect of sugammadex on PPCs.…”

Using NSQIP Data to Reduce Institutional Postoperative Pneumonia Rates in Non-ICU Patients: A Plan-Do-Study-Act Approach

“…Such continued residual paralysis may result in pulmonary complications such as pulmonary edema, atelectasis, aspiration, and pneumonia, leading to reintubation. Complete reversal of neuromuscular blockade may result in reduced postoperative pulmonary complications (23,24).…”