Systematic Evaluation of Neuromuscular Reversal Agents in Obese Patients After General Anesthesia for Bariatric Surgery

Abstract

Background: There is no consensus regarding reversing neuromuscular blockade (NMB) under general anesthesia. For obese patients, complete and rapid recovery from NMB is essential. Objective: This study compared the effectiveness of methods to restore spontaneous breathing for obese patients who underwent laparoscopic sleeve gastrectomy after general anesthesia. Materials and Methods: Medical records were reviewed for those who underwent laparoscopic sleeve gastrectomy between January 2019 and December 2020. Patients were divided into two groups: (1) reversal of NMB (REV), who received a muscle relaxant antagonist; (2) received nothing (NONE). The REV group had two subgroups: sugammadex (SUG) and neostigmine (NEO). Groups were compared for extubation, recovery, hospitalization after surgery, and total hospitalization times. Major metabolic parameters were evaluated postoperatively at 1 and 6 months. Results: Time to extubation, recovery, hospitalization after surgery, and total hospitalization in the REV group were significantly shorter than in the NONE group. Moreover, the extubation time and hospitalization after surgery in the SUG group were significantly lower than in the NEO group. At each postoperative follow-up, both groups were comparable for all metabolism-related indicators. Conclusion: SUG was more effective for obese patients who underwent bariatric surgery with general anesthesia. The metabolism of obese patients might not be affected by the means to restore spontaneous breathing.