Abstract
The use of sugammadex can reduce post-operative residual neuromuscular blockade, which is known to increase the risk of post-operative respiratory events. However, its effect on post-operative pulmonary complications is not obvious. This study was performed to evaluate the effects of sugammadex on post-operative pulmonary complications in patients undergoing laparoscopic gastrectomy between 2013 and 2017. We performed propensity score matching to correct for selection bias. Post-operative pulmonary complications (i.e., pneumonia, respiratory failure, pleural effusion, atelectasis, pneumothorax, and aspiration pneumonitis) were evaluated from the radiological and laboratory findings. We also evaluated admission to the intensive care unit after surgery, re-admission or an emergency room visit within 30 days after discharge, length of hospital stay, re-operation, and mortality within 90 days post-operatively as secondary outcomes. In the initial cohort of 3802 patients, 541 patients were excluded, and 1232 patients were analyzed after propensity score matching. In the matched cohort, pleural effusion was significantly reduced in the sugammadex group compared to the neostigmine group (neostigmine 23.4% vs. sugammadex 18%, p = 0.02). Other pulmonary complications and secondary outcomes were not significantly different between the groups. In comparison to neostigmine, the use of sugammadex was associated with a lower incidence of post-operative pleural effusion in laparoscopic gastrectomy.
Highlights
In general anesthesia, neuromuscular blockade provides appropriate surgical conditions and patient safety by inhibiting involuntary movement of the patient [1,2]
The secondary purpose was to evaluate the relationships between types of reversal agent and other post-operative outcomes, including re-operation within 90 days, intensive care unit (ICU) admission, re-admission or an emergency room visit within 30 days, length of hospital stay, and mortality within 90 days
The 1363 patients who received sugammadex, and the 1898 patients who received neostigmine were included in the analysis (Figure 1)
Summary
Neuromuscular blockade provides appropriate surgical conditions and patient safety by inhibiting involuntary movement of the patient [1,2]. Reversal agents are commonly used to reduce residual neuromuscular blockade. Neostigmine increases the acetylcholine in both the nicotinic and muscarinic receptors, so cholinergic side effects (e.g., bradycardia, bronchoconstriction, post-operative nausea and vomiting) can occur. To prevent such side effects, choline antagonists, such as glycopyrrolate or atropine, should be administered; these can lead to a dry mouth, tachycardia, and urinary retention. Sugammadex forms a complex with aminosteroidal agents to induce the rapid and complete reversal of even deeper neuromuscular blockade, and it significantly reduces post-operative residual blockade [8,9,10]. The secondary purpose was to evaluate the relationships between types of reversal agent and other post-operative outcomes, including re-operation within 90 days, intensive care unit (ICU) admission, re-admission or an emergency room visit within 30 days, length of hospital stay, and mortality within 90 days
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call