Randomized comparison of sugammadex and neostigmine for reversal of rocuronium-induced muscle relaxation in morbidly obese undergoing general anaesthesia

Gaszyński, Tomasz; Szewczyk, Tomasz; Gaszyński, Wojciech

doi:10.1093/bja/aer330

Cited by 122 publications

(92 citation statements)

References 14 publications

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“…Morbidly obese patients are prone to postoperative respiratory complications, including hypoventilation, hypoxaemia, hypercarbia and airway obstruction [8].…”

Section: Discussionmentioning

confidence: 99%

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Residual curarization and postoperative respiratory complications following laparoscopic sleeve gastrectomy. The effect of reversal agents: sugammadex vs. neostigmine

Ezri

Evron

Petrov

et al. 2015

The Journal of Critical Care Medicine

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Background: Incomplete muscle relaxant reversal or re-curarization may be associated with postoperative respiratory complications. In this retrospective study we compared the incidence of postoperative residual curarization and respiratory complications in association with the type of muscle relaxant reversal agent, sugammadex or neostigmine, in patients undergoing laparoscopic sleeve gastrectomy. Material and methods:We reviewed the charts of all patients (179) undergoing laparoscopic sleeve gastrectomy from July 2012 to July 2013 at Wolfson Medical Center. Sugammadex 1.5-2 mg/kg (112 patients) or neostigmine 2.5 mg (67 patients) were used as reversal agents. Results were compared by the type of reversal agent employed. Compared parameters included demographic and anaesthetic data, residual curarization, oxyhemoglobin saturation (SpO 2 ) in the recovery room (PACU), episodes of SpO 2 lower than 90% in PACU, unexpected intensive care (ICU) admissions, incidence of atelectasis and pneumonia, re-intubation and duration of hospitalization. Results: Obstructive sleep apnea syndrome (OSAS) was more frequent in the sugammadex group (19% vs. 8%; p = 0.026). Total intravenous anesthesia (TIVA) was more frequently associated with sugammadex (33% vs. 16%; p = 0.007). There were no differences in postoperative residual curarization, SpO 2 < 90% episodes, reintubation, ICU admissions, pulmonary complications and duration of hospitalization. Conclusion: With the inherent limitations of a retrospective study, the use of sugammadex following laparoscopic sleeve gastrectomy showed no advantage over neostigmine in terms of residual curarization and respiratory complications.

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“…Morbidly obese patients are prone to postoperative respiratory complications, including hypoventilation, hypoxaemia, hypercarbia and airway obstruction [8].…”

Section: Discussionmentioning

confidence: 99%

“…The time to reach a train-of-four ratio (TOFR) ≥ 90% was 13 minutes with 50 μg/kg neostigmine and only 1.7 minutes with 2 mg/kg sugammadex [8]. It follows that sugammadex may be better at preventing the occurrence of residual curarization and possibly postoperative respiratory complication when compared to neostigmine.…”

Section: Introductionmentioning

confidence: 99%

Residual curarization and postoperative respiratory complications following laparoscopic sleeve gastrectomy. The effect of reversal agents: sugammadex vs. neostigmine

Ezri

Evron

Petrov

et al. 2015

The Journal of Critical Care Medicine

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“…Gaszynski et al studied reversal of rocuroniuminduced neuromuscular block with sugammadex 2 mgÁkg -1 corrected body weight or neostigmine 50 lg corrected body weight in 70 morbidly obese patients. 116 They showed that the time to achieve 90% train-of-four (TOF) ratio was significantly shorter in the sugammadex group than the neostigmine group at 2.7 vs 9.6 min, respectively (P \ 0.05), and the TOF ratio in the PACU was 109.8% in the sugammadex group vs 85.5% in the neostigmine group (P \ 0.05). Care should be taken to understand the dosing weight used when reading studies in this area.…”

Section: Postoperative Managementmentioning

confidence: 99%

Perioperative management of the severely obese patient: a selective pathophysiological review

Cullen

Ferguson

2012

Can J Anesth/J Can Anesth

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“…This patient had both restrictive and obstructive pulmonary disease, and the deep neuromuscular block should be reversed adequately. Therefore, we administered the recommended dose of sugammadex to obtain prompt recovery of the neuromuscular function 6 . Sugammadex does not cause increase in bronchial secretions, which was very important in a patient with copious secretions.…”

Section: Discussionmentioning

confidence: 99%

Successful anesthetic management of a kyphoscoliotic Hurler syndrome patient with sugammadex in ventriculoperitoneal shunt surgery

Şen¹,

Özdemi̇r²,

Erdivanlı³

et al. 2016

Kafkas J Med Sci

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Randomized comparison of sugammadex and neostigmine for reversal of rocuronium-induced muscle relaxation in morbidly obese undergoing general anaesthesia

Abstract: Administration of sugammadex provides fast recovery of neuromuscular function and prevents PORC in the morbidly obese, however neostigmine does not.

Cited by 122 publications

References 14 publications

Residual curarization and postoperative respiratory complications following laparoscopic sleeve gastrectomy. The effect of reversal agents: sugammadex vs. neostigmine

Residual curarization and postoperative respiratory complications following laparoscopic sleeve gastrectomy. The effect of reversal agents: sugammadex vs. neostigmine

Perioperative management of the severely obese patient: a selective pathophysiological review

Successful anesthetic management of a kyphoscoliotic Hurler syndrome patient with sugammadex in ventriculoperitoneal shunt surgery

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