Use of sugammadex in lung cancer patients undergoing video-assisted thoracoscopic lobectomy

Abstract

BackgroundThis study aimed to retrospectively evaluate the use of sugammadex in patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy.MethodsData were obtained from medical record review of patients who underwent VATS lobectomy from January 2013 to November 2014. Fifty patients were divided into two groups: the sugammadex group (group S, n = 19) was administered sugammadex 2 mg/kg, while the pyridostigmine group (group P, n = 31) received pyridostigmine 20 mg with glycopyrrolate 0.2 mg or atropine 0.5 mg. The primary endpoint measure was the overall incidence of postoperative pulmonary complications including prolonged air leak, pneumonia, and atelectasis. The secondary endpoint measures were the length of postoperative hospital stay and duration of chest tube insertion.ResultsThe overall incidence of postoperative pulmonary complications in patients in group S was significantly lower compared with that of group P (5 [26.3%] vs. 17 [54.8%]; P = 0.049). Also, the durations of chest tube insertion (5.0 [4.0–7.0] vs. 7.0 [6.0–8.0] days; P = 0.014) and postoperative hospital stay (8.0 [8.0–10.0] vs. 10.0 [9.0–11.0] days; P = 0.019) were shorter in group S compared with group P. Administration of sugammadex was associated reduced with postoperative pulmonary complications (OR: 0.22; 95% CI: 0.05–0.87; P = 0.031).ConclusionsThe use of sugammadex, compared with pyridostigmine, showed a significantly reduced overall incidence of postoperative pulmonary complications and decreased duration of chest tube use and postoperative hospital stay in patients undergoing VATS lobectomy, suggesting that sugammadex might be helpful in improving clinical outcomes in such patients.

Comparison of postoperative pulmonary complications between sugammadex and neostigmine in lung cancer patients undergoing video-assisted thoracoscopic lobectomy: a prospective double-blinded randomized trial

“…Furthermore, the risk of cardiovascular complications is also relatively high with neostigmine because of hemodynamic changes caused by bradycardia and cardiac arrhythmias [ 7 ]. However, theoretically, sugammadex is a selective relaxant-binding agent and has a lower risk of cardiopulmonary complications than a combination of neostigmine and atropine [ 3 , 6 , 7 , 16 ]. Moreover, sugammadex possibly reduces the time required for complete recovery from NMB without increasing the incidence of hypersensitivity or anaphylactic reactions, even in deep blocks [ 16 – 18 ].…”

“…Based on the results of Cho et al [ 3 ], in which the overall incidence of PPCs was 54.8% in the control group and 26.3% in the experimental group, 46 subjects were needed in each group to detect statistically significant differences (α = 0.05, power = 0.80). Thus, 51 patients per group were enrolled to compensate for potential dropouts (drop rate = 10%).…”

“…Particularly, in the field of anesthesia management, neuromuscular blockade (NMB) and its reversal are important because deep NMB is necessary during thoracoscopic lung surgery to secure a good field of view and operating space for the surgeon. Additionally, the choice of reversal agent used to reverse NMB after surgery is important for proper recovery by reducing postoperative residual NMB (PRNMB) [ 1 , 3 ]; this is important for patient safety in the early postoperative period because PRNMB increases the incidence of adverse respiratory events, such as impaired upper airway function, increased risk of aspiration, and respiratory insufficiency [ 4 – 6 ].…”

“…As a cholinesterase inhibitor, neostigmine mainly inhibits acetylcholine breakdown, increases acetylcholine levels in the neuromuscular junction, and enhances the ability of acetylcholine to compete with non-depolarized muscle relaxants at the receptor [ 3 , 7 ]. However, in several studies on the routine use of neostigmine, the incidence of PRNMB on arrival to the post-anesthesia care unit did not change.…”

“…Similarly, sugammadex is a selective relaxant binding agent that rapidly reverses moderate or deep NMB. It is a synthetically modified gamma-cyclodextrin with a hydrophilic exterior and a hydrophobic core, specifically designed to encapsulate steroidal neuromuscular blocking agents [ 3 , 6 , 7 ]. Sugammadex reverses NMB more rapidly and effectively than cholinesterase inhibitors, even at deep block levels, by directly binding to steroidal neuromuscular blocking agents without residual muscle relaxation [ 3 , 8 ].…”