Perioperative Efficiency of Sugammadex Following Laparoscopic Cholecystectomy in Clinical Practice

Abstract

Background: Studies have proposed that the routine use of the modified gamma-cyclodextrin, sugammadex, could provide perioperative time savings. However, these investigations have been limited to small group analyses. The purpose of this study was to test the effectiveness of sugammadex on perioperative times when compared to neostigmine under general clinical practice conditions following rocuronium-induced neuromuscular blockade for laparoscopic cholecystectomy. Methods: Following institutional review board approval, data from 1,611 consecutive surgical records for laparoscopic cholecystectomy were reviewed. Patient characteristics, type of primary neuromuscular blocking reversal agent, operating room (OR) discharge times, and postanesthesia care unit (PACU) recovery times were the measures of interest. Equivalence testing was used to determine the between-group differences of the reversal agents in the two perioperative time periods of interest. Results: OR discharge times averaged 10.9 (95% CI, 10-11.8) minutes for patients administered sugammadex and 8.9 (95% CI, 8.2-9.7) minutes for patients administered neostigmine. PACU recovery times averaged 77.6 (95% CI, 74.1-81.1) minutes for sugammadex and 68.6 (95% CI, 65.9-71.3) minutes for neostigmine. Equivalence testing demonstrated no improvement in the two perioperative times with sugammadex. Conclusion: These results suggest no perioperative time savings with sugammadex when compared to neostigmine following laparoscopic cholecystectomy under general clinical practice conditions.

Hawthorne Effect: More Than Just Telephones

“… 34 Although sugammadex was associated with shorter operating room times of ∼12.5 minutes, the time savings with sugammadex were largely associated with shorter surgical times. 34 We conducted a post hoc analysis of reversal agents by surgical times 35 and found that as surgical times for laparoscopic cholecystectomy increased, a higher percentage of sugammadex was used for reversal of rocuronium-induced neuromuscular blockade ( Figure 1 ). Lower median and interquartile range [IQR] surgical times for neostigmine (53 [IQR 39-75] minutes) were observed when compared to sugammadex (64 [IQR 42-99] minutes) surgical times (chi-square=120, P <0.0001).…”

“…These analyses support the hypothesis 34 that in cases with longer surgical times, sugammadex may allow for faster completion of surgery as the number of studentized sugammadex outliers was less ( Figure 2 ). Nevertheless, in the study by Lee, Ahsan, Chae, et al, 35 the authors explored the perioperative efficiency of this gamma-cyclodextrin for improving operating room discharge and postanesthesia care unit recovery times without favorable results.…”