Abstract
BackgroundRapid neuromuscular block reversal at the end of major abdominal surgery is recommended to avoid any postoperative residual block. To date, no study has evaluated sugammadex performance after rocuronium administration in patients undergoing liver transplantation.This is a randomized controlled trial with the primary objective of assessing the neuromuscular transmission recovery time obtained with sugammadex versus neostigmine after rocuronium induced neuromuscular blockade in patients undergoing orthotopic liver transplantation.MethodsThe TOF-Watch SX®, calibrated and linked to a portable computer equipped with TOF-Watch SX Monitor Software®, was used to monitor and record intraoperative neuromuscular block maintained with a continuous infusion of rocuronium. Anaesthetic management was standardized as per our institution’s internal protocol. At the end of surgery, neuromuscular moderate block reversal was obtained by administration of 2 mg/kg of sugammadex or 50 mcg/kg of neostigmine (plus 10 mcg/kg of atropine).ResultsData from 41 patients undergoing liver transplantation were analysed. In this population, recovery from neuromuscular block was faster following sugammadex administration than neostigmine administration, with mean times±SD of 9.4 ± 4.6 min and 34.6 ± 24.9 min, respectively (p < 0.0001).ConclusionSugammadex is able to reverse neuromuscular block maintained by rocuronium continuous infusion in patients undergoing liver transplantation. The mean reversal time obtained with sugammadex was significantly faster than that for neostigmine. It is important to note that the sugammadex recovery time in this population was found to be considerably longer than in other surgical settings, and should be considered in clinical practice.Trial registrationClinicalTrials.govNCT02697929 (registered 3rd March 2016).
Highlights
Rapid neuromuscular block reversal at the end of major abdominal surgery is recommended to avoid any postoperative residual block
The use of neuromuscular blocking drug (NMBD) at high dosages to achieve deep neuromuscular block (NMB) may be associated with increased postoperative residual curarization (PORC) that leads to pulmonary complications and may even hinder successful extubation [6,7,8]
Both the administration of NMBD reversal agents at the end of surgery and the use of neuromuscular transmission (NMT) monitoring throughout the surgical procedure are key factors to counteract the adverse outcomes related to impaired neuromuscular transmission after extubation [9,10,11,12]
Summary
Rapid neuromuscular block reversal at the end of major abdominal surgery is recommended to avoid any postoperative residual block. The use of NMBD at high dosages to achieve deep NMB may be associated with increased postoperative residual curarization (PORC) that leads to pulmonary complications and may even hinder successful extubation [6,7,8] Both the administration of NMBD reversal agents at the end of surgery and the use of neuromuscular transmission (NMT) monitoring throughout the surgical procedure are key factors to counteract the adverse outcomes related to impaired neuromuscular transmission after extubation [9,10,11,12]. International guidelines and expert opinions strongly recommend NMT monitoring to optimize the dosage and timing of both NMBD and reversal agent administration, with the upshot of enabling early and safe extubation This is strongly encouraged in OLT settings, due to it being able to affect patient outcome directly as well as being a cost-effective practice [13,14,15,16,17,18]
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