Effect of Sugammadex on Postoperative Bleeding and Coagulation Parameters After Septoplasty: A Randomized Prospective Study

Taş, Nilay; Korkmaz, Hakan; Yağan, Özgür; Korkmaz, Mukadder

doi:10.12659/msm.894971

Cited by 26 publications

(18 citation statements)

References 12 publications

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“…Two studies reported no differences in the MAP of patients administered neostigmine and sugammadex; however, this was only in the neostigmine group, whereas the HR was lower at first and subsequently became higher [ 18 , 21 ]. Other studies determined that there were no significant differences in the HR and MAP for both agents [ 11 , 19 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

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Effects of Sugammadex and Neostigmine on Renal Biomarkers

et al. 2016

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BackgroundNeostigmine, the currently commonly used agent for reversal of neuromuscular blockade. Sugammadex is a novel and unique compound designed as an antagonist of steroidal neuromuscular blockers. In this study, we evaluated the effects of sugammadex or neostigmine on kidney functions in patients scheduled for elective surgery.Material/MethodsPatients scheduled for a surgical procedure under desflurane/opioid anesthesia received an intubating dose rocuronium. Patients were divided into 2 groups receiving either sugammadex or neostigmine atropine to reverse neuromuscular blockade. Cystatin C, creatinine, urea, blood urea nitrogen, sodium, potassium, and calcium levels in the blood and α1microglobulin, β2microglobulin, and microalbumin levels in the urine were measured.ResultsThere was no significant difference between the groups with regard to the demographic data. In the Neostigmine Group, although β2microglobulin and microalbumin were similar, a significant increase was found in the postoperative α1microglobulin and cystatin C values. In the Sugammadex Group, although β2-microglobulin and cystatin C were similar, a significant increase was found in the postoperative α1-microglobulin and microalbumin values. The only significant difference was cystatin C value variation in the Neostigmine Group compared to the Sugammadex Group.ConclusionsWe believe that the use of more specific and sensitive new-generation markers like cystatin C to evaluate kidney function will provide a better understanding and interpretation of our results. Sugammadex has more tolerable effects on kidney function in patients than does neostigmine. However, when compared to preoperative values, there is a negative alteration of postoperative values. Neostigmine and sugammadex do not cause renal failure but they may affect kidney function.

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Section: Discussionmentioning

confidence: 99%

“…There are studies in the literature comparing the effects of sugammadex and neostigmine [ 8 , 13 , 18 , 19 ]. However, few of these studies were primarily designed to evaluate the effects of sugammadex and neostigmine on renal function.…”

Section: Introductionmentioning

confidence: 99%

Effects of Sugammadex and Neostigmine on Renal Biomarkers

et al. 2016

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“…Despite transient (within 1 h) increases in APTT and PT in the sugammadex group, there was no increased risk of bleeding versus usual care. In another study of patients undergoing septoplasty, the authors evaluated the total amount of blood absorbed by the nasal dressings in the first 3 postoperative hours [ 72 ]. In this study, no statistically significant difference was found in PT and APTT values between the patients who received 2 mg/kg sugammadex and those who received neostigmine.…”

Section: Reviewmentioning

confidence: 99%

Preparing for the unexpected: special considerations and complications after sugammadex administration

et al. 2017

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Sugammadex, a modified gamma-cyclodextrin, has changed clinical practice of neuromuscular reversal dramatically. With the introduction of this selective relaxant binding agent, rapid and reliable neuromuscular reversal from any depth of block became possible. Sugammadex can reverse neuromuscular blockade without the muscarinic side effects typically associated with the administration of acetylcholinesterase inhibitors. However, what remained unchanged is the incidence of residual neuromuscular blockade. It is known that sugammadex cannot always prevent its occurrence, if appropriate dosing is not chosen based on the level of neuromuscular paralysis prior to administration determined by objective neuromuscular monitoring. Alternatively, excessive doses of sugammadex administered in an attempt to ensure full and sustained reversal may affect the effectiveness of rocuronium in case of immediate reoperation or reintubation. In such emergent scenarios that require onset of rapid and reliable neuromuscular blockade, the summary of product characteristics (package insert) recommends using benzylisoquinolinium neuromuscular blocking agents or a depolarizing agent. However, if rapid intubation is required, succinylcholine has a significant number of side effects, and benzylisoquinolinium agents may not have the rapid onset required. Therefore, prior administration of sugammadex introduces a new set of potential problems that require new solutions. This novel reversal agent thus presents new challenges and anesthesiologists must familiarize themselves with specific issues with its use (e.g., bleeding risk, hypermagnesemia, hypothermia). This review will address sugammadex administration in such special clinical situations.

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“…Regarding its clinical implication, no study has demonstrated evidence of increased bleeding risk after sugammadex use except 1 study. [ 11 ] Even the author of this study commented that increased bleeding that they found may associate with other uncontrolled factors rather than sugammadex. In line with previous studies, our study demonstrated that the amount of drain volume was similar in both sugammadex and pyridostigmine groups.…”

Section: Discussionmentioning

confidence: 89%

“…[ 12 , 16 ] Following clinical studies in surgical patients also reported the similar coagulation abnormalities. [ 10 , 11 ] Thus, according to the current drug supplementation, additional caution should be exercised when used in high-dose or in patients with high risk of bleeding. [ 17 ] Not only sugammadex may cause coagulation abnormality, but liver resection also causes PT prolongation because of consumptive or dilutional coagulopathy after hepatic resection.…”

Section: Discussionmentioning

confidence: 99%

Comparison of postoperative coagulation profiles and outcome for sugammadex versus pyridostigmine in 992 living donors after living-donor hepatectomy

Moon

Kim

et al. 2018

Medicine

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Donor safety is the major concern in living donor liver transplantation, although hepatic resection may be associated with postoperative coagulopathy. Recently, the use of sugammadex has been gradually increased, but sugammadex is known to prolong prothrombin time (PT) and activated partial thromboplastin time (aPTT). We compared the postoperative coagulation profiles and outcomes of sugammadex versus pyridostigmine group in donors receiving living donor hepatectomy.Consecutive donor hepatectomy performed between September 2013 and August 2016 was retrospectively analyzed. For reversal of rocuronium-induced neuromuscular blockade, donors received sugammadex 4 mg/kg or pyridostigmine 0.25 mg/kg. The primary end-points were laboratory findings (PT, aPTT, hemoglobin, platelet count) and clinically evaluated postoperative bleeding (relaparotomy for bleeding, cumulative volume collected in drains). Secondary outcomes were anesthesia time, postoperative hospital day.Of 992 donors, 383 treated with sugammadex and 609 treated with pyridostigmine for the reversal of neuromuscular blockade. There were no significant differences between both groups for drop in hemoglobin and platelet, prolongation in PT, aPTT, and the amount of 24-h drain volume. Bleeding events within 24 h were reported in 2 (0.3%) for pyridostigmine group and 0 (0%) for sugammadex group (P = .262). Anesthesia time was significantly longer in pyridostigmine group than that in sugammadex group (438.8 ± 71.4 vs. 421.3 ± 62.3, P < .001). Postoperative hospital stay was significantly longer in pyridostigmine group than that in sugammadex group (P = .002).Sugammadex 4 mg/kg was not associated with increased bleeding tendency, but associated with reduced anesthesia time and hospital stay. Therefore, sugammadex may be safely used and will decrease morbidity in donor undergoing living-donor hepatectomy.

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Effect of Sugammadex on Postoperative Bleeding and Coagulation Parameters After Septoplasty: A Randomized Prospective Study

Cited by 26 publications

References 12 publications

Effects of Sugammadex and Neostigmine on Renal Biomarkers

Effects of Sugammadex and Neostigmine on Renal Biomarkers

Preparing for the unexpected: special considerations and complications after sugammadex administration

Comparison of postoperative coagulation profiles and outcome for sugammadex versus pyridostigmine in 992 living donors after living-donor hepatectomy

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