Improved postoperative oxygenation after antagonism of moderate neuromuscular block with sugammadex versus neostigmine after extubation in ‘blinded’ conditions

Boon, Martijn; Martini, C.H.; Broens, Suzanne; Rijnsoever, E. van; Zwan, Timo van der; Aarts, Leon; Dahan, Albert

doi:10.1093/bja/aew246

Cited by 15 publications

(10 citation statements)

References 5 publications

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“…Numerous studies have investigated the in uence of NMB in respiratory outcome after anesthesia, and neostigmine was shown to have direct detrimental effects [25]. In contrast, other studies reported that after administration of NMB, sugammadex was associated with fewer postoperative adverse respiratory events [26][27]. In this study, administration of sugammadex was associated with fewer PPCs, such as postoperative cough, pleural effusion (all), massive pleural effusion and breathing failure in patients with pulmonary dysfunction before operation.…”

Section: Discussionmentioning

confidence: 58%

Effect of sugammadex on postoperative pulmonary complications in patients with respiratory dysfunction after laparoscopic gastric or intestinal surgery: A retrospective study

Yuan²,

Chen³

et al. 2020

Preprint

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Background Use of sugammadex is associated with fewer postoperative pulmonary complications. This study investigated the relationship between sugammadex and postoperative pulmonary complications (PPC) in specific patients with respiratory dysfunction. Methods The authors reviewed the electronic medical and anesthesia records of patients with respiratory dysfunction who had laparoscopic gastric or intestinal surgery at a single center between May 01, 2018, and December 31, 2019. The patients were divided into the sugammadex group and the non-sugammadex group, based on whether or not they received sugammadex. Binary logistic regression analyses were used to characterize the differences in incidence of PPC. Results A total of 112 patients were included, of which 46 patients (41.07%) received sugammadex. In the logistic regression analysis, the incidences of PPC were fewer in the sugammadex group. Postoperative fever [Odds Ratio (OR) 0.330; 95% Confidence Interval (CI) 0.137–0.793, p = 0.0213], postoperative ICU admission (OR 0.204; 95% CI 0.065 to 0.644, p = 0.007), cough (OR 0.143; 95% CI 0.061 to 0.333, p < 0.001), pleural effusion (all) (OR: 0.280; 95% CI 0.104 to 0.759, p = 0.012), pleural effusion (massive) (OR: 0.142; 95% CI 0.031 to 0.653, p = 0.012), and difficulty in breathing (OR: 0.111; 95% CI 0.014 to 0.849, p = 0.039) showed significant differences between the two groups. Conclusions Sugammadex-mediated reversal of neuromuscular blockade can reduce the PPC in patients with respiratory dysfunction.

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Section: Discussionmentioning

confidence: 58%

Effect of sugammadex on postoperative pulmonary complications in patients with respiratory dysfunction after laparoscopic gastric or intestinal surgery: A retrospective study

Yuan²,

Chen³

et al. 2020

Preprint

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“…Initial evidence from a retrospective study shows that sugammadex reversal was associated with reduced incidence of pulmonary complications in elderly ASA three and four patients compared to reversal with neostigmine 47 . In a small prospective study, sugammadex reversal was associated with fewer hypoxemic events in the PACU compared to neostigmine reversal 39 . The current evidence is far from complete, and future prospective studies should determine the exact value of sugammadex in improving post-anesthesia pulmonary outcome.…”

Section: Prevention Of Postoperative Residual Curarizationmentioning

confidence: 93%

“…A recent investigation reported a 0% PORC rate in patients reversed with sugammadex versus 46% in those who received neostigmine 43 . These results are promising; however, in an unmonitored setting, PORC after sugammadex reversal still occurred in 4% of patients 36 , 39 , 44 . This highlights the need for adequate neuromuscular monitoring in any setting where NMBAs are used, regardless of the type of reversal agent.…”

Section: Prevention Of Postoperative Residual Curarizationmentioning

confidence: 96%

“…It is therefore not surprising that the effect of NMB reversal with neostigmine on postoperative respiratory complications and outcome is, at best, ambiguous. Increasing evidence shows that NMB reversal with neostigmine (without the guidance of a TOF watch) does not improve postoperative respiratory safety 37 and may even be associated with increased rates of atelectasis 38 , hypoxemia 39 , and, consequently, reintubation 40 . There are several explanations for these findings.…”

Section: Prevention Of Postoperative Residual Curarizationmentioning

confidence: 99%

“…Sugammadex has the potential to do better in both respects, as it allows for fast, complete, and predictable reversal of both moderate and deep NMB 15 , 16 , 41 , 42 . Emerging evidence shows that NMB reversal with sugammadex reduces the rate of postoperative residual curarization compared to reversal with neostigmine (see Table 1 ) 36 , 39 , 43 . A recent investigation reported a 0% PORC rate in patients reversed with sugammadex versus 46% in those who received neostigmine 43 .…”

Section: Prevention Of Postoperative Residual Curarizationmentioning

confidence: 99%

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Recent advances in neuromuscular block during anesthesia

2018

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Muscle relaxation is a routine part of anesthesia and has important advantages. However, the lingering effects of muscle relaxants in the postoperative period have historically been associated with postoperative adverse events. Neuromuscular reversal, together with neuromuscular monitoring, is a recognized strategy to reduce the rate of postoperative residual relaxation but has only marginally improved outcome in the past few decades. Sugammadex, a novel reversal agent with unique encapsulating properties, has changed the landscape of neuromuscular reversal and opened up new opportunities to improve patient care. By quickly and completely reversing any depth of neuromuscular block, it may reduce the rate of residual relaxation and improve respiratory recovery. In addition, sugammadex has made the use of deep neuromuscular block possible during surgery. Deep neuromuscular block may improve surgical working conditions and allow for a reduction in insufflation pressures during selected laparoscopic procedures. However, whether and how this may impact outcomes is not well established.

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Measurement of quality of recovery using the postoperative quality of recovery scale (PQRS) in patients undergoing laparoscopic cholecystectomy: A prospective cohort pilot study

Vu,

Bang,

Hieu

et al. 2023

International Journal of Surgery Open

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Objectives Quality of post-operative recovery is an essential end-point for evaluating anesthesia and surgery. Measures must incorporate patient-reported outcomes and satisfaction in addition to physiological indicators of recovery in order to fully assess the effects of anesthesia and surgery. This study is to explore the quality of recovery using the postoperative quality of recovery scale (PQRS) in patients undergoing laparoscopic cholecystectomy. Methods This is a single-center, prospective cohort pilot study. Patients undergoing laparoscopic cholecystectomy were divided into two groups: Group D with deep neuromuscular blockade and Group M with moderate neuromuscular blockade. After surgery, patients were assessed by using Post-operative Quality Recovery Scale (PQRS). Results 60 patients in group D and 60 patients in group M were analyzed. The proportion of patients with excellent surgical conditions in group D was higher than in group M. In the recovery room, at 15 min and 40 min after endotracheal extubation, the recovery of the physiological domain in group D was significantly higher than in group M. In postoperative day 1, the overall recovery percentage was 78.3% in group D and 76.7% in group M. Conclusion This is a pilot study showing that it is feasible and appropriate to use the postoperative quality of recovery scale (PQRS) in postoperative recovery assessment. Preliminary assessment of this result shows that anesthesia strategy with deep rocuronium-induced neuromuscular blockade-sugammadex reversal improved postoperative recovery versus the routine care with moderate neuromuscular block-neostigmine. Highlights

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Improved postoperative oxygenation after antagonism of moderate neuromuscular block with sugammadex versus neostigmine after extubation in ‘blinded’ conditions

Cited by 15 publications

References 5 publications

Effect of sugammadex on postoperative pulmonary complications in patients with respiratory dysfunction after laparoscopic gastric or intestinal surgery: A retrospective study

Effect of sugammadex on postoperative pulmonary complications in patients with respiratory dysfunction after laparoscopic gastric or intestinal surgery: A retrospective study

Recent advances in neuromuscular block during anesthesia

Measurement of quality of recovery using the postoperative quality of recovery scale (PQRS) in patients undergoing laparoscopic cholecystectomy: A prospective cohort pilot study

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