Sugammadex facilitates early recovery after surgery even in the absence of neuromuscular monitoring in patients undergoing laryngeal microsurgery: a single-center retrospective study

Abstract

BackgroundIn many countries, routine clinical anaesthesia does not always involve neuromuscular monitoring. In these clinical settings, the efficacy and safety of sugammadex use has not yet been confirmed. We investigated the efficacy and safety of sugammadex in the absence of neuromuscular monitoring.MethodsOne hundred and forty patients who underwent laryngeal microsurgery with the use of rocuronium as a neuromuscular blocking agent, without the use of a neuromuscular monitoring device, were retrospectively investigated. The patients were randomly chosen among all the patients who met the inclusion criteria at a tertiary university hospital between July 2013 and February 2015 and were allocated to group S (sugammadex group) or group P (pyridostigmine group) according to the neuromuscular reversal agent administered. Five patients were excluded from analysis and 135 patients completed the study. Primary outcome was extubation time. Secondary outcomes were anaesthesia time, the correlation between anaesthesia time and extubation time, the total amount of rocuronium, and postoperative adverse events in the post-anaesthesia care unit (PACU).ResultsExtubation time was significantly shorter in group S (6.3 ± 3.9 min) than in group P (9.0 ± 5.4 min). Anaesthesia time was also significantly shorter in group S (30.7 ± 10.3 min) than in group P (35.8 ± 12.6 min). In the patients with an anaesthesia time of 30 min or less, there was a positive correlation between anaesthesia time and extubation time in group P (r = 0.453), but there was no significant relationship in group S. The total amount of rocuronium used was higher in group S (0.62 ± 0.11 mg kg−1) than in group P (0.38 ± 0.14 mg kg−1). Postoperative adverse events in the PACU were comparable between the groups, except for tachycardia events: the incidence of tachycardia was significantly lower in group S (8.0 %) than in group P (17.3 %).ConclusionsSugammadex could shorten anaesthesia and extubation times as well as recovery time in the PACU and reduce postoperative hemodynamic complications in a clinical setting in the absence of neuromuscular monitoring. This may enhance the patients’ recovery in the operating room and PACU while improving the postoperative condition of patients.Trial registrationThe trial was registered in the UMIN clinical trials registry (www.umin.ac.jp/ctr/index/htm; unique trial number: UMIN000016602; registration number: R000019266; principal investigator’s name: Byung Gun Lim; date of registration: February 22, 2015).Electronic supplementary materialThe online version of this article (doi:10.1186/s12871-016-0221-2) contains supplementary material, which is available to authorized users.

Positive Patient Postoperative Outcomes with Pharmacotherapy: A Narrative Review including Perioperative-Specialty Pharmacist Interviews

“…Dexmedetomidine (now available as a multi-source generic) has been shown to facilitate extubation for earlier PACU discharge [ 65 , 66 ] and mitigate postpartum depression [ 67 ], but, when combined with ketamine as a continuous infusion, may not yield lower opioid consumption or pain scores [ 68 ]. Sugammadex may shorten time to extubation and may accelerate bowel function recovery and shorter postoperative LOS as compared to reversal of neuromuscular blockade with neostigmine and glycopyrrolate [ 69 , 70 ]. For use as a local anesthetic by wound infiltration, liposomal bupivacaine (LB) may reduce opioid use and hospital LOS as well as promote earlier oral diet [ 71 , 72 , 73 ], but this effect may be procedure-specific [ 74 ].…”

Analgesic and Anesthetic Efficacy of Rocuronium/Sugammadex in Otorhinolaryngologic Surgery: A Propensity Score-Matched Analysis

“…Several studies have compared the outcomes of using different neuromuscular blocking drugs and their reversal agents in otorhinolaryngologic surgery [ 10 , 11 , 12 , 14 ]. Our study is the first to investigate the hourly consumption of sevoflurane.…”

“…The use of sugammadex with deep neuromuscular block in elective laryngeal microsurgery (LMS) has been shown to improve intubation conditions and the surgical rating scale [ 10 ]. Sugammadex, used as a reversal agent, has also been shown to have significantly shorter extubation time and fewer tachycardia events in the post-anesthesia care unit (PACU) than pyridostigmine in elective LMS [ 11 ]. Moreover, other studies have shown that reversal with sugammadex results in less diaphragmatic failure [ 12 ] and less postoperative desaturation and hypoxemia [ 13 ].…”

Influence of Reversal with Sugammadex or Neostigmine on Post-Operative Quality of Recovery Following a Single Bolus Dose of Rocuronium: A Prospective, Randomised, Double-Blinded, Controlled Study

“…Sugammadex has been reported to be superior at preserving haemodynamic stability than anticholinesterases, which have been the most commonly used NM blockade reversal agent to date. [15,16] Due to the fear of adverse effects from cholinesterase inhibitors, these have been associated with concomitant used of anticholinergic agents such as atropine or glycopyrrolate. [17,18] However, the combination of these 2 agents having different pharmacokinetic and pharmacodynamic properties cannot completely prevent their adverse effects nor maximize their desired effect.…”