Thirty-Day Postoperative Outcomes Following Sugammadex Use in Colorectal Surgery Patients: Retrospective Study

Chae, Yun Jeong; Joe, Han Bum; Oh, Joa Sub; Lee, Eunyoung; Yi, In Kyong

doi:10.3390/jcm8010097

Cited by 17 publications

(33 citation statements)

References 32 publications

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“…38 Chae et al also reported no differences in 30-day postoperative outcomes after sugammadex and acetylcholinesterase inhibitor use. 39 Thus, our results are in line with previous published studies.…”

Section: Perioperative Medicinesupporting

confidence: 94%

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

Freundlich

Gupta

et al. 2021

Anesthesiology

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Background Postoperative residual neuromuscular blockade related to nondepolarizing neuromuscular blocking agents may be associated with pulmonary complications. In this study, the authors sought to determine whether sugammadex was associated with a lower risk of postoperative pulmonary complications in comparison with neostigmine. Methods Adult patients from the Vanderbilt University Medical Center National Surgical Quality Improvement Program database who underwent general anesthesia procedures between January 2010 and July 2019 were included in an observational cohort study. In early 2017, a wholesale switch from neostigmine to sugammadex occurred at Vanderbilt University Medical Center. The authors therefore identified all patients receiving nondepolarizing neuromuscular blockades and reversal with neostigmine or sugammadex. An inverse probability of treatment weighting propensity score analysis approach was applied to control for measured confounding. The primary outcome was postoperative pulmonary complications, determined by retrospective chart review and defined as the composite of the three postoperative respiratory occurrences: pneumonia, prolonged mechanical ventilation, and unplanned intubation. Results Of 10,491 eligible cases, 7,800 patients received neostigmine, and 2,691 received sugammadex. A total of 575 (5.5%) patients experienced postoperative pulmonary complications (5.9% neostigmine vs. 4.2% sugammadex). Specifically, 306 (2.9%) patients had pneumonia (3.2% vs. 2.1%), 113 (1.1%) prolonged mechanical ventilation (1.1% vs. 1.1%), and 156 (1.5%) unplanned intubation (1.6% vs. 1.0%). After propensity score adjustment, the authors found a lower absolute incidence rate of postoperative pulmonary complications over time (adjusted odds ratio, 0.91 [per year]; 95% CI, 0.87 to 0.96; P < .001). No difference was observed on the odds of postoperative pulmonary complications in patients receiving sugammadex in comparison with neostigmine (adjusted odds ratio, 0.89; 95% CI, 0.65 to 1.22; P = 0.468). Conclusions Among 10,491 patients at a single academic tertiary care center, the authors found that switching neuromuscular blockade reversal agents was not associated with the occurrence of postoperative pulmonary complications. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Section: Perioperative Medicinesupporting

confidence: 94%

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

Freundlich

Gupta

et al. 2021

Anesthesiology

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“…In this context, few studies have been conducted to investigate the effects of sugammadex on bowel movements [7][8][9][10]. Moreover, only a small number of studies have compared the recovery of intestinal movement in groups administered AChEIs and anticholinergic agents and those administered sugammadex, although the studies were conducted retrospectively [11]. This study, therefore, aimed to evaluate the contribution of sugammadex as a reversal agent to the recovery of gastrointestinal (GI) motility in patients undergoing laparoscopic cholecystectomy compared to the contribution of the combination of pyridostigmine and glycopyrrolate.…”

Section: Introductionmentioning

confidence: 99%

Neuromuscular blockade reversal with sugammadex versus pyridostigmine/glycopyrrolate in laparoscopic cholecystectomy: a randomized trial of effects on postoperative gastrointestinal motility

Noh

Kim

Lee

et al. 2020

Korean J Anesthesiol

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Background: Acetylcholinesterase inhibitors (e.g., pyridostigmine bromide) are used for neuromuscular blockade (NMB) reversal in patients undergoing surgery under general anesthesia (GA). Concurrent use of anticholinergic agents (e.g., glycopyrrolate) decreases cholinergic side effects but can impede bowel movements. Sugammadex has no cholinergic effects; its use modifies recovery of gastrointestinal (GI) motility following laparoscopic cholecystectomy compared to pyridostigmine/glycopyrrolate. This study evaluated the contribution of sugammadex to the recovery of GI motility compared with pyridostigmine and glycopyrrolate. Methods: We conducted a prospective study of patients who underwent laparoscopic cholecystectomy. Patients were randomly allocated to the experimental group (sugammadex, Group S) or control group (pyridostigmine-glycopyrrolate, Group P). After anesthesia (propofol and rocuronium, and 2% sevoflurane), recovery was induced by injection of sugammadex or a pyridostigmine-glycopyrrolate mixture. As a primary outcome, patients recorded the time of their first passage of flatus ('gas-out time') and defecation. The secondary outcome was stool types. Results: One-hundred and two patients participated (Group S [n = 49], Group P [n = 53]). Mean time from injection of NMB reversal agents to gas-out time was 15.03 (6.36-20.25) h in Group S and 20.85 (16.34-25.86) h in Group P (P = 0.001). Inter-group differences were significant. Time until the first defecation as well as types of stools was not significantly different. Conclusions: Sugammadex after laparoscopic cholecystectomy under GA resulted in an earlier first postoperative passage of flatus compared with the use of a mixture of pyridostigmine and glycopyrrolate. These findings suggest that the use of sugammadex has positive effects on the recovery of GI motility.

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“…Oh et al [ 96 ] revealed that unplanned 30-day readmission after major abdominal surgery decreased with sugammadex use. Chae et al [ 97 ] indicated that reversal with sugammadex decreased the incidence of delayed discharge.…”

Section: Recent Clinical Interests Regarding Sugammadexmentioning

confidence: 99%

Advantages and pitfalls of clinical application of sugammadex

Lee

Jung

2020

Anesth Pain Med

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Sugammadex, a modified γ-cyclodextrin, is one of the drugs focused on in the anesthetic field because it provides rapid and complete reversal from neuromuscular blockade (NMB) by encapsulating rocuronium. Its introduction has revolutionized anesthesia practice because it is a safe, predictable, and reliable neuromuscular antagonist. Hence, its use has increased worldwide. Further, it has been in the spotlight for recovering from deep NMB in laparoscopic surgery and improving the surgical condition. Recently, studies have been conducted on the postoperative outcome after deep NMB and use of sugammadex in various clinical conditions. However, with increase in sugammadex use, reports regarding its complications are increasing. Appropriate dosing of sugammadex with quantitative neuromuscular monitoring is emphasized because under-dosing or over-dosing of sugammadex might be associated with unexperienced complications. Sugammadex is now leaping into an ideal reversal agent, changing the anesthesia practice.

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Thirty-Day Postoperative Outcomes Following Sugammadex Use in Colorectal Surgery Patients: Retrospective Study

Cited by 17 publications

References 32 publications

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

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

Neuromuscular blockade reversal with sugammadex versus pyridostigmine/glycopyrrolate in laparoscopic cholecystectomy: a randomized trial of effects on postoperative gastrointestinal motility

Advantages and pitfalls of clinical application of sugammadex

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