The Relationship between the Timing of Sugammadex Administration and the Upper Airway Obstruction during Awakening from Anesthesia: A Retrospective Study.

Eunsu Kang,Daeseok Oh,Byeong Cheol Lee,Jae Hong Park,Myoung Jin Ko,Se Hun Kim,Sang Eun Lee,Dae Yun Choi

doi:10.3390/medicina57020088

Eunsu Kang, Daeseok Oh + Show 6 more

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https://doi.org/10.3390/medicina57020088

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Abstract

Background and Objectives: The harmonization of recovery of consciousness and muscular function is important in emergence from anesthesia. Even if muscular function is recovered, tracheal extubation without adequate recovery of consciousness may increase the risk of respiratory complications. In particular, upper airway obstruction is one of the common respiratory complications and can sometimes be fatal. However, the association between the timing of sugammadex administration and the upper airway obstruction that can occur during awakening from anesthesia has rarely been studied. Materials and Methods: The medical records of 456 patients who had surgery under general endotracheal anesthesia (GETA) at the Haeundae Paik Hospital between October 2017 and July 2018 and who received intravenous sugammadex to reverse rocuronium-induced neuromuscular blockade were analyzed. The correlations between bispectral index (BIS) and minimum alveolar concentration (MAC) at the time of sugammadex administration, the incidence of complications, and the time to tracheal extubation were analyzed to investigate how different timings of sugammadex administration affected upper airway obstruction after tracheal extubation. Conclusions: The effect of BIS and the duration from anesthetic discontinuation to sugammadex administration on upper airway obstruction was not statistically significant. However, the odds ratio of complication rates with MAC < 0.3 compared with MAC ≥ 0.3 was 0.40 (95% confidence interval 0.20 to 0.81, p = 0.011), showing a statistically significant increase in risk with MAC ≥ 0.3 for upper airway obstruction.

Highlights

The onset of action of any medication and its interaction with other drugs should be considered to maximize its therapeutic effects and minimize adverse effects [1]
We investigated the distribution in durations between anesthetic discontinuation and sugammadex administration (T2-time when an inhalation anesthetic was discontinued (T1), min) as well as whether these durations have any correlation with the incidence of respiratory complications after extubation
The patients were classified into two groups for each independent variable using its median value: sugammadex administration 2 min before or after discontinuation of inhalation anesthetics, bispectral index (BIS) value less than or greater than 60, and minimum alveolar concentration (MAC) value less than or greater than 0.3 MAC

Summary

Introduction

The onset of action of any medication and its interaction with other drugs should be considered to maximize its therapeutic effects and minimize adverse effects [1]. There is an optimal time for the administration of any medication, those used for reversing the effects of muscle relaxants after general endotracheal anesthesia (GETA) since they are known to have optimal action times. All different levels of neuromuscular blockade are reversed within 2 to 3 min after administration of sugammadex [2,3] This rapid reversal of neuromuscular blockade using sugammadex may affect emergence depending on the residual inhalation anesthetics. Materials and Methods: The medical records of 456 patients who had surgery under general endotracheal anesthesia (GETA) at the Haeundae Paik Hospital between October 2017 and July 2018 and who received intravenous sugammadex to reverse rocuronium-induced neuromuscular blockade were analyzed.

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