Introduction of sugammadex as standard reversal agent: Impact on the incidence of residual neuromuscular blockade and postoperative patient outcome

Abstract

Background:The aim of this prospective audit was to investigate clinical practice related to muscle relaxant reversal and the impact made by the recent introduction of sugammadex on patient outcome at a tertiary teaching hospital.Methods:Data from all patients intubated at our institution during two epochs of seven consecutive days each was collected prospectively. Directly prior to extubation, the train-of-four (TOF) ratio was assessed quantitatively by an independent observer. Postoperative outcome parameters were complications in the recovery room and radiological diagnosed atelectasis or pneumonia within 30 days.Results:Data from 146 patients were analysed. Three reversal strategies were used: no reversal, neostigmine or sugammadex. The TOF ratio was less than 0.7 in 17 patients (nine no reversal, eight neostigmine) and less than 0.9 in 47 patients (24 no reversal, 19 neostigmine, four sugammadex). Those reversed with sugammadex showed fewer episodes of postoperative oxygen desaturation (15% vs. 33%; P<0.05). TOF ratios of less than 0.7 (P<0.05) and also <0.9 (P<0.01) were more likely associated with X-ray results consistent with postoperative atelectasis or pneumonia.Conclusions:Our results suggest a significant impact of residual paralysis on patient outcome. The use of sugammadex resulted in the lowest incidence of residual paralysis.

Residual Neuromuscular Blockade in the Critical Care Setting

“…No difference was noted among the reversal agents for PONV, need for reintubation, or cardiac disturbances. 25 The results of this study suggest that sugammadex has clear advantages over neostigmine, providing a quicker return to baseline for TOF measurement and decreases in respiratory compromise.…”

“…25 More patients given sugammadex returned to a TOF ratio of more than 0.9 prior to extubation compared with patients who were given neostigmine or no reversal. No difference was noted among the reversal agents for PONV, need for reintubation, or cardiac disturbances.…”

Sugammadex: A revolutionary drug in neuromuscular pharmacology

“…[33] It will prove useful for very short surgeries when an intermediate acting NMB is used or when the dose, timing or administration of neostigmine is inadequate. Surgeons should no longer encounter inadequate muscle relaxation and anesthesiologists should no longer encounter patients whose NMB is difficult to reverse at the end of surgery.…”

A Short Update on Sugammadex with a Special Focus on Economic Assessment of its Use in North America

“…Although anesthesiologists believe that postoperative residual paralysis induced by non-depolarizing NMBA occurs in less than 1% of the cases [39], residual curarization is a very frequent complication that could involve up to 83% of the patients in the postoperative period even with the introduction of shorter-acting muscle relaxants [40]. Residual blockade can trigger adverse postoperative pulmonary events, pharyngeal dysfunction, the need for urgent tracheal reintubation and prolonged stay in post-anesthesia care unit (PACU) [41].…”