Antagonization of neuromuscular blockade by sugammadex vs. neostigmine in patients undergoing robotic‑assisted urological procedures – effect on extubation time and quality of the recovery – monocentric prospective randomized study

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Authors: J. Schraml ¹; V. Kokoška ¹; M. Broul ^1,2; R. Škulec ^3,4; J. Škola ³; D. Astapenko ⁵; V.- Černý ^{3,5,6 8}
Authors‘ workplace: Klinika urologie a robotické chirurgie, Univerzita J. E. Purkyně v Ústí nad Labem, Masarykova nemocnice v Ústí nad Labem ¹; Sexuologické oddělení, Masarykova nemocnice v Ústí nad Labem ²; Klinika anesteziologie, perioperační a intenzivní medicíny, Univerzita J. E. Purkyně v Ústí nad Labem, Masarykova nemocnice v Ústí nad Labem ³; Zdravotnická záchranná služba Středočeského kraje ⁴; Klinika anesteziologie, resuscitace a intenzivní medicíny, Fakultní nemocnice Hradec Králové a Lékařská fakulta, v Hradci Králové, Univerzita Karlova ⁵; Centrum pro výzkum a vývoj, Fakultní nemocnice Hradec Králové ⁶; Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Kanada ⁷; Technická univerzita v Liberci ⁸
Published in: Anest. intenziv. Med., 32, 2021, č. 4-5, s. 191-196
Category: Original Papers

Overview

Objective: The aim of the study was to test the hypothesis that the use of sugammadex shortens the time to extubation
compared to the use of neostigmine in patients undergoing robotically assisted urological procedures.
Design: Monocentric prospective randomized study.
Setting: Tertiary Care Hospital.
Material and methods: Sixty adult patients undergoing robotic-assisted urological laparoscopic surgery without contraindications
to the administration of rocuronium, neostigmine and sugammadex, with perioperative monitoring of the depth
of neuromuscular blockade. Patients were randomized to the group with antagonization of the neuromuscular blockade
with either neostigmine or sugammadex. Primary outcome was time to extubation from injection of the antagonist.
Results: Sixty-one patients with ASA I–III were enrolled. The time to extubation was significantly shorter in the sugammadex
group compared to neostigmine group: 10; 3.5–35 minutes, 45; 16–88 minutes respectively, p < 0.00001 (data shown as
an average; minimum – maximum range). In addition, patients in the sugammadex group were transported significantly
faster from the operating room. There were no differences in the quality and rate of recovery in 72 hours postoperatively.
Conclusion: Sugammadex statistically significantly accelerated the time from administration to extubation in ASA I–III
patients after robotic-assisted urologic laparoscopic surgery compared to neostigmine. Thus, sugammadex significantly
accelerated the patients’ operating room turn-over time.

Keywords:

robotic surgery – Neuromuscular blockade – sugammadex – neostigmine – extubation

Sources

Raval AD, Uyei J, Karabis A, Bash LD, Brull SJ. Incidence of residual neuromuscular blockade and use of neuromuscular blocking agents with or without antagonists: A systematic review and meta‑analysis of randomized controlled trials. J Clin Anesth. 2020; 15(64): 109818. doi: 10.1016/j.jclinane.2020.109818.
Raval AD, Anupindi VR, Ferrufino CP, Arper DL, Bash LD, Brull SJ. Epidemiology and outcomes of residual neuromuscular blockade: A systematic review of observational studies. J Clin Anesth. 2020; 66: 109962. doi: 10.1016/j.jclinane.2020.109962.
Lee HY, Jung KT. Advantages and pitfalls of clinical application of sugammadex. Anesth pain Med. 2020; https://doi.org/10.17085/APM.19099.
Carvalho H, Verdonck M, Cools W, Geerts L, Forget P, Poelaert J. Forty years of neuromuscular monitoring and postoperative residual curarisation: a meta‑analysis and evaluation of confidence in network meta‑analysis. Br J Anaesth. 2020; 125(4): 466–482. doi: 10.1016/j.bja.2020. 05. 063.
Pei D‑Q, Zhou H‑M, Zhou Q‑H. Grip strength can be used to evaluate postoperative residual neuromuscular block recovery in patients undergoing general anesthesia. Medicine (Baltimore). 2019; 98: e13940.
Khuenl‑Brady KS, Wattwil M, Vanacker BF, Lora‑Tamayo JI, Rietbergen H, Alvarez‑Gómez JA. Sugammadex provides faster reversal of vecuronium‑induced neuromuscular blockade compared with neostigmine: a multicenter, randomized, controlled trial. Anesth Analg. 2010; 110(1): 64–73. doi: 10.1213/ane.0b013e3181ac53c3.
Carron M, Zarantonello F, Tellaroli P, Ori C. Efficacy and safety of sugammadex compared to neostigmine for reversal of neuromuscular blockade: a meta‑analysis of randomized controlled trials. J Clin Anesth. 2016; 35: 1–12. doi: 10.1016/j.jclinane.2016. 06. 018.
Alday E, Muñoz M, Planas A, Mata E, Alvarez C. Effects of neuromuscular block reversal with sugammadex versus neostigmine on postoperative respiratory outcomes after major abdominal surgery: a randomized‑controlled trial. Can J Anaesth. 2019; 66(11): 1328–1337. doi: 10.1007/s12630-019-01419-3.
Li G, Freundlich RE, Gupta RK, Hayhurst CJ, Le CH, Martin BJ, et al. Postoperative Pulmonary Complications’ Association with Sugammadex versus Neostigmine. Anesthesiology. 2021. doi: 10.1097/ALN.0000000000003735.
Mulier JP, De Boeck L, Meulders M, Beliën J, Colpaert J, Sels A. Factors determining the smooth flow and the non‑operative time in a one‑induction room to one‑operating room setting. J Eval Clin Pract. 2015; 21(2): 205–214. doi: 10.1111/jep.12288.
Masursky D, Dexter F, Kwakye MO, Smallman B. Measure to quantify the influence of time from end of surgery to tracheal extubation on operating room workflow. Anesth Analg. 2012; 115(2) :402–406. doi: 10.1213/ANE.0b013e318257a0f2.
Dexter F, Epstein RH. Increased mean time from end of surgery to operating room exit in a historical cohort of cases with prolonged time to extubation. Anesth Analg. 2013; 117(6): 1453–1459. doi: 10.1213/ANE.0b013e3182a44d86.
Cammu G. Residual Neuromuscular Blockade and Postoperative Pulmonary Complications: What Does the Recent Evidence Demonstrate? Curr Anesthesiol Rep. 2020; 27: 1–6. doi: 10.1007/s40140-020-00388-4.
Kumar GV, Nair AP, Murthy HS, Jalaja KR, Ramachandra K, Parameshwara G. Residual neuromuscular blockade affects postoperative pulmonary function. Anesthesiology. 2012; 117(6): 1234–1244. doi: 10.1097/ALN.0b013e3182715b80.
Kheterpal S, Vaughn MT, Dubovoy TZ, Shah NJ, Bash LD, Colquhoun DA, et al. Sugammadex versus Neostigmine for Reversal of Neuromuscular Blockade and Postoperative Pulmonary Complications (STRONGER): A Multicenter Matched Cohort Analysis. Anesthesiology. 2020; 132(6): 1371–1381. doi: 10.1097/ALN.0000000000003256.
Royse CF, Newman S, Chung F, Stygall J, McKay RE, Boldt J, et al. Development and feasibility of a scale to assess postoperative recovery: the post‑operative quality recovery scale.Anesthesiology. 2010; 113(4): 892–905. doi: 10.1097/ALN.0b013e3181d960a9.
Carron M, Baratto F, Zarantonello F, Ori C. Sugammadex for reversal of neuromuscular blockade: a retrospective analysis of clinical outcomes and cost‑effectiveness in a single center. Clinicoecon Outcomes Res. 2016; 18(8): 43–52. doi: 10.2147/CEOR.S100921.
Paton F, Paulden M, Chambers D, Heirs M, Duffy S, Hunter JM, et al. Sugammadex compared with neostigmine/glycopyrrolate for routine reversal of neuromuscular block: a systematic review and economic evaluation. Br J Anaesth. 2010; 105(5): 558–567. doi: 10.1093/bja/aeq269.
19. Martinez‑Ubieto J, Aragón‑Benedí C, de Pedro J, Cea‑Calvo L, Morell A, Jiang Y, et al. Economic impact of improving patient safety using Sugammadex for routine reversal of neuromuscular blockade in Spain. BMC Anesthesiol. 2021; 21(1): 55. doi: 10.1186/s12871-021-01248-2.
Motamed C, Bourgain JL. Comparison of the Time to Extubation and Length of Stay in the PACU after Sugammadex and Neostigmine Use in Two Types of Surgery: A Monocentric Retrospective Analysis. J Clin Med. 2021; 10(4): 815. doi: 10.3390/jcm10040815.
Hurford WE, Welge JA, Eckman MH. Sugammadex versus neostigmine for routine reversal of rocuronium block in adult patients: A cost analysis. J Clin Anesth. 2020; 67: 110027. doi: 10.1016/j.jclinane.2020.110027.
Blobner M, Hunter JM, Meistelman C, Hoeft A, Hollmann MW, Kirmeier E, Lewald H, Ulm K. Use of a train‑of‑four ratio of 0.95 versus 0.9 for tracheal extubation: an exploratory analysis of POPULAR data. Br J Anaesth. 2020 Jan; 124(1): 63–72. doi: 10.1016/j.bja.2019. 08. 023. Epub 2019 Oct 10. PMID: 31607388.