TY - JOUR
T1 - Sugammadex versus neostigmine for reversal of rocuronium-induced neuromuscular blockade
T2 - A randomized, double-blinded study of thoracic surgical patients evaluating hypoxic episodes in the early postoperative period
AU - Moon, Tiffany S.
AU - Reznik, Scott
AU - Pak, Taylor
AU - Jan, Kathryn
AU - Pruszynski, Jessica
AU - Kim, Agnes
AU - Smith, Katelynn M.
AU - Lu, Rachael
AU - Chen, Joy
AU - Gasanova, Irina
AU - Fox, Pamela E.
AU - Ogunnaike, Babatunde
N1 - Publisher Copyright:
© 2020
PY - 2020/9
Y1 - 2020/9
N2 - Study objective: This objective of this study was to determine if reversal of rocuronium-induced neuromuscular blockade with sugammadex versus neostigmine results in a decreased number of hypoxic episodes in the early postoperative period in patients undergoing thoracic surgery with single lung ventilation. Design: Single-center, randomized, double-blind, two-arm clinical trial. Setting: Operating room and postanesthesia care unit. Patients: 92 subjects aged ≥18, American Society of Anesthesiologists physical status II-IV, and undergoing a thoracic operation necessitating single lung ventilation. Interventions: Subjects received either 2 mg/kg sugammadex or 50 μg/kg neostigmine with 8 μg/kg glycopyrrolate for reversal of moderate neuromuscular blockade. Measurements: For the first 90 min postoperatively, all episodes of hypoxia were recorded. Neuromuscular monitoring was performed with acceleromyography (TOF-Watch® SX) and the train of four (TOF) was recorded at 2, 5, 10, and 15 min after administration of the neuromuscular reversal agent. Main results: Subjects who received neostigmine had a median of 1 episode (interquartile range IQR: 0–2.2) of hypoxia versus subjects who received sugammadex who had a median of 0 episodes (IQR: 0–1) (p = 0.009). The mean time to recovery of TOF ≥ 0.9 was significantly faster with sugammadex at 10 min (95% confidence interval CI: 5–15) compared with neostigmine at 40 min (95% CI: 15–53) (p < 0.001). Conclusions: In thoracic surgical patients necessitating single lung ventilation, sugammadex provides faster reversal of moderate neuromuscular blockade and results in a decreased number of postoperative hypoxic episodes compared with neostigmine.
AB - Study objective: This objective of this study was to determine if reversal of rocuronium-induced neuromuscular blockade with sugammadex versus neostigmine results in a decreased number of hypoxic episodes in the early postoperative period in patients undergoing thoracic surgery with single lung ventilation. Design: Single-center, randomized, double-blind, two-arm clinical trial. Setting: Operating room and postanesthesia care unit. Patients: 92 subjects aged ≥18, American Society of Anesthesiologists physical status II-IV, and undergoing a thoracic operation necessitating single lung ventilation. Interventions: Subjects received either 2 mg/kg sugammadex or 50 μg/kg neostigmine with 8 μg/kg glycopyrrolate for reversal of moderate neuromuscular blockade. Measurements: For the first 90 min postoperatively, all episodes of hypoxia were recorded. Neuromuscular monitoring was performed with acceleromyography (TOF-Watch® SX) and the train of four (TOF) was recorded at 2, 5, 10, and 15 min after administration of the neuromuscular reversal agent. Main results: Subjects who received neostigmine had a median of 1 episode (interquartile range IQR: 0–2.2) of hypoxia versus subjects who received sugammadex who had a median of 0 episodes (IQR: 0–1) (p = 0.009). The mean time to recovery of TOF ≥ 0.9 was significantly faster with sugammadex at 10 min (95% confidence interval CI: 5–15) compared with neostigmine at 40 min (95% CI: 15–53) (p < 0.001). Conclusions: In thoracic surgical patients necessitating single lung ventilation, sugammadex provides faster reversal of moderate neuromuscular blockade and results in a decreased number of postoperative hypoxic episodes compared with neostigmine.
KW - Hypoxia
KW - Neuromuscular blockade
KW - Sugammadex
KW - Thoracic surgery
KW - Train of four
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U2 - 10.1016/j.jclinane.2020.109804
DO - 10.1016/j.jclinane.2020.109804
M3 - Article
C2 - 32353805
AN - SCOPUS:85083790480
SN - 0952-8180
VL - 64
JO - Journal of Clinical Anesthesia
JF - Journal of Clinical Anesthesia
M1 - 109804
ER -