Sugammadex versus neostigmine for reversal of rocuronium-induced neuromuscular blockade: A randomized, double-blinded study of thoracic surgical patients evaluating hypoxic episodes in the early postoperative period

Tiffany S. Moon, Scott Reznik, Taylor Pak, Kathryn Jan, Jessica Pruszynski, Agnes Kim, Katelynn M. Smith, Rachael Lu, Joy Chen, Irina Gasanova, Pamela E. Fox, Babatunde Ogunnaike

Research output: Contribution to journalArticlepeer-review

Abstract

Study objective: This objective of this study was to determine if reversal of rocuronium-induced neuromuscular blockade with sugammadex versus neostigmine results in a decreased number of hypoxic episodes in the early postoperative period in patients undergoing thoracic surgery with single lung ventilation. Design: Single-center, randomized, double-blind, two-arm clinical trial. Setting: Operating room and postanesthesia care unit. Patients: 92 subjects aged ≥18, American Society of Anesthesiologists physical status II-IV, and undergoing a thoracic operation necessitating single lung ventilation. Interventions: Subjects received either 2 mg/kg sugammadex or 50 μg/kg neostigmine with 8 μg/kg glycopyrrolate for reversal of moderate neuromuscular blockade. Measurements: For the first 90 min postoperatively, all episodes of hypoxia were recorded. Neuromuscular monitoring was performed with acceleromyography (TOF-Watch® SX) and the train of four (TOF) was recorded at 2, 5, 10, and 15 min after administration of the neuromuscular reversal agent. Main results: Subjects who received neostigmine had a median of 1 episode (interquartile range IQR: 0–2.2) of hypoxia versus subjects who received sugammadex who had a median of 0 episodes (IQR: 0–1) (p = 0.009). The mean time to recovery of TOF ≥ 0.9 was significantly faster with sugammadex at 10 min (95% confidence interval CI: 5–15) compared with neostigmine at 40 min (95% CI: 15–53) (p < 0.001). Conclusions: In thoracic surgical patients necessitating single lung ventilation, sugammadex provides faster reversal of moderate neuromuscular blockade and results in a decreased number of postoperative hypoxic episodes compared with neostigmine.

Original languageEnglish (US)
Article number109804
JournalJournal of Clinical Anesthesia
Volume64
DOIs
StatePublished - Sep 2020

Keywords

  • Hypoxia
  • Neuromuscular blockade
  • Sugammadex
  • Thoracic surgery
  • Train of four

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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