Reversal of Deep Effect of Rocuronium by Sugammadex or Neostigmine after Abdominal Laparoscopic Surgery: A Single Center Experience in Vietnam

Abstract

BACKGROUND: Using sugammadex allows to quickly reverse deep neuromuscular blockade with rocuronium in laparoscopic surgery, which results in great benefits during and after surgery by minimizing the problem of postoperative residual curarization.
 AIM: The aims of this study are comparing the efficacy of reversing neuromuscular blockade between sugammadex and neostigmine and evaluating its unwanted effects after laparoscopic abdominal surgery.
 METHODS: Subject of this prospective clinical comparative trial was patients who underwent abdominal laparoscopic surgery at 103 Military Hospital from October 2017 to October 2018. Eighty-four patients suffering from abdominal laparoscopic surgery under deep neuromuscular blockade were enrolled and divided randomly into two groups with 42 patients in each: Group N used neostigmine for neuromuscular blockade reversal and Group S applied sugammadex. At the end of surgery, neuromuscular blockade was reversed with either sugammadex or neostigmine.
 RESULTS: The reversal time to achieve train-of-four ratio >0.9 in the sugammadex group was 2.42 ± 0.58 min, which was shorter than in the neostigmine group (11.83 ± 2.19 min) (p < 0.05). The time until extubation in the sugammadex group was 3.69 ± 0.67 min, which was shorter than in the neostigmine group 11.90 ± 2.22 min (p < 0.05). Reversal with sugammadex resulted in statistical significance of less sputum production (0% vs. 11.9%), dry mouth (0% vs. 28.57%), headache (2.38% vs. 7.14%), and nausea (4.76% vs. 14.28%) compared with neostigmine. However, 26.19% of patients in the neostigmine group presented bradycardia, whereas the concurrent administration of atropine in the neostigmine group resulted in increased heart rate.
 CONCLUSION: Sugammadex reversed neuromuscular blockade more rapidly and effectively than neostigmine in abdominal laparoscopic surgeries. The unwanted effects of sugammadex group were fewer than neostigmine group.

2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade: A Report by the American Society of Anesthesiologists Task Force on Neuromuscular Blockade

“…Times to train-of-four ratio greater than or equal to 0.9 were shorter in patients antagonized with sugammadex compared with neostigmine from deep 65,69–71 to moderate 62,72–85 depths of blockade (moderate strength of evidence) and from shallow 86–90 (moderate strength of evidence) to minimal 69 depths of blockade (very low strength of evidence; supplementalfigs. S9 to S12, http://links.lww.com/ALN/C929).…”

“…Postoperative nausea was reported in 31 studies (26 randomized controlled trials, 61,62,65,67,69–71,73,74,77,79–81,84,100,102,132–141 1 nonrandomized study, 142 and 3 cohort studies 48,143,144 ). No difference was apparent between sugammadex and neostigmine (very low strength of evidence; supplemental fig.…”

“…The body of evidence enrolling adults included 191 studies (133 randomized controlled trials, 4,59–90,92,95,98–104,110–114,118–127,132–141,145–148,155–157,163,173–181,206–254 11 nonrandomized trials, 17,128,142,182–184,191,255–258 45 cohort studies, 15,42,86,91,93,94,96,97,105–109,116,117,129–131,143,144,186–190,227,259–277 and 2 before–after designs 115,168 ) evaluating efficacy and safety of antagonist drugs for neuromuscular blockade. The randomized controlled trials enrolling only adults had a median of 88 participants (range, 16 to 350).…”

Superiority of sugammadex in preventing postoperative pulmonary complications

“…Residual neuromuscular paralysis impairs the diaphragm as well as chest wall strength and reduces the patient's ability to cough and clear secretions, which leads to alveolar collapse, microaspiration, and other pulmonary complications [39] . Furthermore, reversal with sugammadex results in less sputum production [40] . The advantage of sugammadex is more than shortening neuromuscular recovery duration regardless of the degree of the blockade.…”

“…[ 39 ] Furthermore, reversal with sugammadex results in less sputum production. [ 40 ] The advantage of sugammadex is more than shortening neuromuscular recovery duration regardless of the degree of the blockade. Both neuromuscular monitoring and clinical signs show residual postoperative curarization happens less frequently with sugammadex than neostigmine, [ 32 , 33 , 9 ] which indicates sugammadex can reduce postoperative pulmonary complications than neostigmine.…”