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

Abstract

Background: Reversal of neuromuscular blockade (NMB) at the end of surgery is important for reducing postoperative residual NMB; this is associated with an increased risk of postoperative pulmonary complications (PPCs). Moreover, PPCs are associated with poor prognosis after video-assisted thoracoscopic surgery (VATS) for lobectomy. We compared the effects of two reversal agents, sugammadex and neostigmine, on the incidence of PPCs and duration of hospital stay in patients undergoing VATS lobectomy.Methods: After VATS lobectomy was completed under neuromuscular monitoring, the sugammadex group (n = 46) received sugammadex 2 mg/kg, while the neostigmine group (n = 47) received neostigmine 0.05 mg/kg with atropine 0.02 mg/kg after at least the third twitch in response to the train of four stimulation. The primary outcome was incidence of PPCs. The secondary outcomes were duration of hospital stay and intensive care unit (ICU) admission. Results: There was no significant difference in the incidence of PPCs for both the sugammadex and neostigmine groups (32.6% and 40.4%, respectively; risk difference = 0.08; 95% confidence interval = [−0.12, 0.27]; P = 0.434). The lengths of hospital (P = 0.431) and ICU (P = 0.964) stays were not significantly different between the two groups.Conclusions: The clinical use of sugammadex and neostigmine in NMB reversal for patients undergoing VATS lobectomy was not significantly different in the incidence of PPCs and duration of hospital and ICU stay.

Effect of Deep versus Moderate Neuromuscular Blockade on Quantitatively Assessed Postoperative Atelectasis Using Computed Tomography in Thoracic Surgery; a Randomized Double-Blind Controlled Trial

“…Instead, achieving a greater than 0.9 TOF ratio for tracheal extubation using an appropriate dose of sugammadex would contribute to little difference between both groups. Recent studies have compared the incidence of PPCs and showed similar results between the deep and the moderate NMB groups [ 8 , 16 ]. However, maintaining intraoperative deep NMB may contribute to increased lung compliance [ 17 ].…”

Comparison Effects of two Muscle Relaxant Strategies on Postoperative Pulmonary Complications in Transapical Transcatheter Aortic Valve Implantation: A Propensity Score-Matched Analysis

“…We included patients with aortic valve disease who had poor clinical conditions from older age, more comorbidities and higher European system for cardiac risk evaluation (EuroSCORE) score when compared with other studies which included non-cardiac surgery patients (15,17,19,21,34,39,43,44). As a result, the postoperative hospital LOS (7.5 days) in our study was longer than other studies (3.5 to 7.5 days) (15,21,34,(43)(44)(45) except one study including major abdominal surgery patients (12.5 days) (19).…”

Choice of neuromuscular block reversal agent to reduce postoperative pulmonary complications

“…Similarly, in a retrospective study of patients undergoing single-port video-assisted lung lobectomy, early postoperative abnormalities on chest radiography were significantly lesser with sugammadex than with pyridostigmine [ 71 ]. However, according to an RCT conducted on patients undergoing video-assisted lung lobectomy in 2021, there was no difference in the incidence of PPCs between sugammadex and neostigmine [ 72 ]. The extubation criterion was set at TOF ratio ≥ 0.9 in the RCT study, suggesting the possibility that the complications were not different.…”