Clinical Impact of Sugammadex in the Reversal of Neuromuscular Blockade

Goodner, Joshua A; Likar, Eric J; Hoff, Abigail L; Quedado, Jeffrey; Kohli, Arpan; Ellison, Pavithra R

doi:10.7759/cureus.15413

Cited by 3 publications

(2 citation statements)

References 4 publications

(8 reference statements)

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“…At that time, a change in anaesthetic technique was implemented in order to extubate patients in the operating room and reduce the need for postoperative mechanical ventilation. Among others, the systematic use of sugammadex in patients undergoing ultrafast track was considered given the accelerated reversal of neuromuscular blockage [ 19 ]. There is evidence of the superiority of this drug over others in shortening the time of surgical mechanical ventilation.…”

Section: Discussionmentioning

confidence: 99%

Ultrafast track versus conventional fast track in patients undergoing cardiac surgery: a propensity score-matched analysis

Carnero-Alcázar,

Beltrao-Sial,

Montero-Cruces

et al. 2023

Interdisciplinary CardioVascular and Thoracic Surgery

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OBJECTIVES We aimed at comparing the risk of major adverse events and length of stay between patients undergoing ultrafast track and conventional fast track. METHODS Retrospective cohort study adjusted by propensity score matching, including patients operated on between March 2020 and December 2022 of any of the following: coronary, valve surgery or ascending aorta surgery. Patients were divided into 2 groups: ultrafast track: extubation in the operating room and fast track: extubation attempted in the first 6 postoperative hours. The primary objective was to compare the risk of the combined event death, lung respiratory outcomes (reintubation, mechanical ventilation longer than 24 h or pneumonia), or acute renal failure. RESULTS A total of 1126 patients were included. A total of 579 (51.4%) were extubated in the operating room. A total of 331 pairs were available after matching by propensity score. The risk of the primary outcome was 11.8% (n = 39) in the fast-track group and 6.3% (n = 21) in the ultrafast-track group (P = 0.013), mostly driven by lung adverse events (6.9% vs 2.4%, P = 0.011) while no significant differences were detected in the risk of death (2.4% vs 1.8%, P = 0.77) or acute renal failure (8% vs 6.3%, P = 0.56). The risk of myocardial infarction was higher in the fast-track group (2.7% vs 0%, P = 0.039). The median length of stay in the postoperative intensive care unit was longer in the fast-track group [24.7 h (interquartile range 21.5; 62.9) vs 23.5 h (interquartile range 22; 46), P = 0.015]. CONCLUSIONS In patients undergoing cardiac surgery, extubation in the operating room is associated to a lower risk of postoperative complications (mostly driven by lung adverse events) and length of stay in intensive care unit as compared to fast track.

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Section: Discussionmentioning

confidence: 99%

Ultrafast track versus conventional fast track in patients undergoing cardiac surgery: a propensity score-matched analysis

Carnero-Alcázar,

Beltrao-Sial,

Montero-Cruces

et al. 2023

Interdisciplinary CardioVascular and Thoracic Surgery

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“…Laparoscopic surgery requires a good muscle relaxant, and muscle relaxants are essential adjuvant drugs in general anesthesia, facilitating endotracheal intubation during general anesthesia and maintaining good muscle relaxants during surgery. [ 4 ] Vecuronium has no histamine-releasing effect and less adverse reactions, and is a commonly used non-depolarizing neuromuscular blocker in general anesthesia. Excessive use of intraoperative inotropes can lead to delayed postoperative recovery of patients.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the synergistic effects of sevoflurane and desflurane on muscle relaxant vecuronium in laparoscopic colon cancer surgery

Song¹,

Zhao²,

Wang³

et al. 2022

Medicine

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Sevoflurane and desflurane are commonly used inhalation anesthetics in clinical practice. This study compared the synergistic effects of sevoflurane and desflurane on the muscarinic agent vecuronium in laparoscopic colon cancer surgery. The aim of this study was to compare sevoflurane and desflurane in a synergistic effect on the muscle relaxant vecuronium in laparoscopic colon cancer surgery. Sixty patients undergoing elective laparoscopic radical resection of colon cancer were randomly divided into sevoflurane (n = 30) and desflurane (n = 30) groups. After anesthesia and successful tracheal intubation, patients in both groups were maintained with combined remifentanil. Muscle relaxant effects were monitored in both groups using a muscle relaxant monitor (train of stimuli-Watch), the onset time, T1 and T2 recovery time, and muscle relaxant dosage of vecuronium were observed. Hemodynamic changes were observed in both groups, and the dosage of vasoactive drugs was recorded. The quality of recovery of the patients was evaluated using the Mini-Mental State Examination (MMSE) and the discharge from the Aldrete score criteria. There was no significant difference in the onset time of vecuronium between the two groups (P > .05). The desflurane group's T1 and T2 recovery times were later than that of the sevoflurane group. The dosage of vecuronium was statistically significantly less than that in the sevoflurane group (P < .05); the extubation time in the desflurane group was statistically significantly longer than that in the sevoflurane group (P < .05). There were no significant differences in preoperative and intraoperative mean arterial pressure, heart rate, ephedrine and atropine dosage, MMSE score, and Aldrete score between the 2 groups (P > .05). Compared with sevoflurane, desflurane has a stronger synergistic effect on the muscle relaxant of vecuronium without increasing the incidence of cardiovascular adverse reactions and affecting patient recovery.Abbreviations: BIS = bispectral index, HR = heart rate, MAP = mean arterial pressure, MMSE = Mini-Mental State Examination, P et co 2 = pressure of end-tidal carbon dioxide, TOF = train of stimuli.

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Postoperative pulmonary complications after sugammadex reversal of neuromuscular blockade: a systematic review and meta-analysis with trial sequential analysis

Zuo

et al. 2023

BMC Anesthesiol

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Background Sugammadex has been reported to lower the incidence of postoperative residual neuromuscular blockade. Despite the advantages, until recently the effects of sugammadex on postoperative pulmonary complications (PPCs) were controversial. We conducted a systematic review and meta-analysis to determine whether reversal with sugammadex was associated with a lower risk of PPCs compared with neostigmine. Methods PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched from inception to May 2022. Randomized controlled trials (RCTs) and observational studies comparing PPCs in patients receiving sugammadex or neostigmine as reversal agent at the end of surgery were included. The primary outcomes focused on PPCs including desaturation, pneumonia, atelectasis, noninvasive ventilation (NIV) and reintubation. Trial sequential analysis was performed on the primary outcomes to confirm whether firm evidence was reached. Results Meta-analysis of included studies showed that the rate of desaturation (43.2% vs 45.0%, RR = 0.82; 95% CI 0.63 to 1.05; p = 0.11) were comparable between the two groups. When looking at other primary outcomes, significantly lower risk of pneumonia (1.37% vs 2.45%, RR = 0.65; 95% CI 0.49 to 0.85; p = 0.002), atelectasis (24.6% vs 30.4%, RR = 0.64; 95% CI 0.42 to 0.98; p = 0.04), NIV (1.37% vs 2.33%, RR = 0.65; 95% CI 0.43 to 0.98; p = 0.04) and reintubation (0.99% vs 1.65%, RR = 0.62; 95% CI 0.43 to 0.91; p = 0.01) in the sugammadex group were detected compared with the neostigmine group. Conclusions We concluded that sugammadex is more effective at reducing the incidence of PPCs including pneumonia, atelectasis, NIV and reintubation compared with neostigmine. Further evidence, preferably from RCTs, is required to confirm these findings.

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Clinical Impact of Sugammadex in the Reversal of Neuromuscular Blockade

Cited by 3 publications

References 4 publications

Ultrafast track versus conventional fast track in patients undergoing cardiac surgery: a propensity score-matched analysis

Ultrafast track versus conventional fast track in patients undergoing cardiac surgery: a propensity score-matched analysis

Comparison of the synergistic effects of sevoflurane and desflurane on muscle relaxant vecuronium in laparoscopic colon cancer surgery

Postoperative pulmonary complications after sugammadex reversal of neuromuscular blockade: a systematic review and meta-analysis with trial sequential analysis

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