Abstract
During robot-assisted radical cystectomy (RARC), specific surgical conditions (a steep Trendelenburg position, prolonged pneumoperitoneum, effective myoresolution until the final stages of surgery) can seriously impair the outcomes. The aim of the study was to evaluate the incidence of postoperative nausea and vomiting (PONV) and ileus and the quality of cognitive function at the awakening in two groups of patients undergoing different reversals. In this randomized trial, patients that were American Society of Anesthesiologists physical status (ASA) ≤III candidates for RARC for bladder cancer were randomized into two groups: In the sugammadex (S) group, patients received 2 mg/kg of sugammadex as reversal of neuromuscolar blockade; in the neostigmine (N) group, antagonization was obtained with neostigmine 0.04 mg/kg + atropine 0.02 mg/kg. PONV was evaluated at 30 min, 6 and 24 h after anesthesia. Postoperative cognitive functions and time to resumption of intestinal transit were also investigated. A total of 109 patients were analyzed (54 in the S group and 55 in the N group). The incidence of early PONV was lower in the S group but not statistically significant (S group 25.9% vs. N group 29%; p = 0.711). The Mini-Mental State test mean value was higher in the S group vs. the N group (1 h after surgery: 29.3 (29; 30) vs. 27.6 (27; 30), p = 0.007; 4 h after surgery: 29.5 (30; 30) vs. 28.4 (28; 30), p = 0.05). We did not observe a significant decrease of the PONV after sugammadex administration versus neostigmine use. The Mini-Mental State test mean value was greater in the S group.
Highlights
The diffusion of robot-assisted laparoscopic techniques has made it possible to perform surgical procedures with greater precision, and has reduced the need for transfusions, postoperative complications and hospitalization time [1]
We investigated if the use of a different kind of neuromuscular blockade (NMB) reversal can influence the early postoperative period after a prolonged major surgery, such as robot-assisted radical cystectomy (RARC), affected by alterations on mechanical ventilation, cerebral perfusion, and vascular resistances [10]
The mean OASS value was significantly higher in the sugammadex group (S group) compared with the neostigmine group (N group) 1 h after the end of anesthesia (median and 25–75th percentile, 5 (5; 5) vs. 5 (4; 5); p = 0.02), but no differences were observed in the first measurement, 30 min after the end of anesthesia (Table 3)
Summary
The diffusion of robot-assisted laparoscopic techniques has made it possible to perform surgical procedures with greater precision, and has reduced the need for transfusions, postoperative complications and hospitalization time [1]. An effective myoresolution until the final stages of surgery is necessary to establish ideal surgical conditions [5] and the factors that can impair the quality and time of awakening [6]. To overcome this effect, a reversal of neuromuscular blockade (NMB) is routinely used in our clinical practice
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