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

• Published in: Journal of clinical anesthesia Vol. 64; p. 109804
• Main Authors: Moon, Tiffany S., Reznik, Scott, Pak, Taylor, Jan, Kathryn, Pruszynski, Jessica, Kim, Agnes, Smith, Katelynn M., Lu, Rachael, Chen, Joy, Gasanova, Irina, Fox, Pamela E., Ogunnaike, Babatunde
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2020; Elsevier Limited
• Subjects: Anesthesia; Drug dosages; Enrollments; Hypoxia; Neuromuscular blockade; Oxygen saturation; Pain Medicine; Patients; Pharmacy; Postoperative period; Statistical analysis; Studies; Sugammadex; Thoracic surgery; Train of four; Ireland; Neuromuscular blockade; Hypoxia; Thoracic surgery; Sugammadex; Train of four
• ISSN: 0952-8180; 1873-4529; 1873-4529
• DOI: 10.1016/j.jclinane.2020.109804

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. Single-center, randomized, double-blind, two-arm clinical trial. Operating room and postanesthesia care unit. 92 subjects aged ≥18, American Society of Anesthesiologists physical status II-IV, and undergoing a thoracic operation necessitating single lung ventilation. Subjects received either 2 mg/kg sugammadex or 50 μg/kg neostigmine with 8 μg/kg glycopyrrolate for reversal of moderate neuromuscular blockade. 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. 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). 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. •Reversal with sugammadex results in less hypoxia compared to neostigmine.•Reversal with neostigmine in thoracic patients can result in residual blockade.•Sugammadex results in a much faster reversal of neuromuscular block than neostigmine.