Comparison of sugammadex and pyridostigmine bromide for reversal of rocuronium-induced neuromuscular blockade in short-term pediatric surgery: A prospective randomized study

The safety of high-dose rocuronium bromide in general anesthesia for spinal surgery and its effects on muscle relaxation

PURPOSE

This study aimed to investigate the effects of high-dose rocuronium bromide in general anesthesia for spinal surgery and analyze its safety.

METHODS

A total of 90 patients with spine diseases who underwent elective spinal surgery in our hospital were enrolled as study subjects, and were divided into 2-fold group (intraoperative administration of 0.6 mg/kg rocuronium bromide, n=30), 3-fold group (0.9 mg/kg rocuronium bromide, n=30) and 4-fold group (1.2 mg/kg rocuronium bromide, n=30). The effects of rocuronium bromide on muscle relaxation, the operative time and the incidence of adverse reactions were compared among the three groups.

RESULTS

The onset time of muscle relaxation in the 4-fold group was significantly lower than that in 2-fold and 3-fold groups. The duration of muscle relaxation and duration of action in the 4-fold group were significantly higher than those in the 2-fold and 3-fold groups (P<0.05). The satisfaction rate in the 4-fold group (100.00%) was significantly higher than that in the 2-fold group (66.67%) and the 3-fold group (86.67%) (P<0.05). The 4-fold group exhibited significantly higher intubating condition score at 1 min and significantly lower operative time than the 2-fold and 3-fold groups (P<0.05). The incidence of adverse reactions in the 4-fold group was 23.33%, slightly higher than those in the 2-fold (20.00%) and 3-fold groups (20.00%) (P>0.05).

CONCLUSION

High-dose rocuronium bromide shortens the onset time of muscle relaxation in patients undergoing spinal surgery, creates better intubation conditions, has longer duration of action, and shortens the patient's operative time, without increasing adverse reactions such as skin flushing, rash, increased airway resistance and bronchospasm, laryngeal edema, etc. Meanwhile, high-dose rocuronium bromide can shorten intubation time, which is conducive to the smooth operation and reduces surgical stress injuries.

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

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.

Opportunities to Improve the Capacity to Rescue: Intraoperative and Perioperative Tools

Postoperative complications, which occur in approximately 23% of surgeries, are a major source of patient mortality. Some of these deaths may be preventable. This article explores factors and contexts during the intraoperative period, in the postanesthesia care unit, perioperatively, and after discharge that may represent opportunities to intervene and prevent mortality after a potentially treatable complication. Tools to improve the identification and response to life-threatening complications in these unique care settings are discussed.

Sugammadex for Fast-Track Surgery in Children Undergoing Cardiac Surgery: A Randomized Controlled Study

OBJECTIVE

The purpose of this study was to evaluate the safety and efficacy of sugammadex for fast-track surgery in children undergoing cardiac surgery.

DESIGN

This was a prospective, randomized, controlled clinical study.

SETTING

University hospital.

PARTICIPANTS

The study comprised 60 children undergoing cardiac surgery.

INTERVENTIONS

The children in group S received sugammadex, 4 mg/kg, for reversal of neuromuscular block, and the children in group N received neostigmine, 30 µg/kg, and atropine, 15 µg/kg.

MEASUREMENTS AND MAIN RESULTS

The recovery time to a train-of-four of 0.9 and extubation time were significantly shorter in the group S than in group N (3.4 ± 1.2 min v 76.2 ± 20.5 min and 31.0 ± 6.4 min v 125.2 ± 21.6 min, respectively; p < 0.01). The heart rate after drug administration was higher in group S than in group N (102.7 ± 9.4 beats/min v 96.9 ± 8.5 beats/min; p = 0.03), whereas the mean arterial pressure after drug administration was similar in both groups. The length of hospital stay was shorter in group S (5.8 ± 1.0 v 6.5 ± 0.9 days; p = 0.03), and the hospitalization expenses were decreased in group S compared with that of group N ($1,036 ± $114 v $1,286 ± $187; p < 0.01). The incidence of postoperative atelectasis was less in group S than in group N (0 v 20%; p = 0.024).

CONCLUSION

Sugammadex can shorten the extubation time and reduce the incidence of postoperative atelectasis, with fewer adverse events, in children undergoing cardiac surgery. It may be beneficial to use sugammadex for fast-track surgery in children undergoing cardiac surgery.