Randomised controlled trial of sugammadex or neostigmine for reversal of neuromuscular block on the incidence of pulmonary complications in older adults undergoing prolonged surgery

British Journal of Anaesthesia
Brandon M TogiokaMiriam M Treggiari

Abstract

Residual neuromuscular block has been associated with postoperative pulmonary complications. We hypothesised that sugammadex reduces postoperative pulmonary complications in patients aged ≥70 yr having surgery ≥3 h, compared with neostigmine. Patients were enrolled in an open-label, assessor-blinded, randomised, controlled trial. At surgical closure, subjects were equally randomised to receive sugammadex 2 mg kg-1 or neostigmine 0.07 mg kg-1 (maximum 5 mg) for rocuronium reversal. The primary endpoint was incidence of postoperative pulmonary complications. Secondary endpoints included residual paralysis (train-of-four ratio <0.9 in the PACU) and Phase 1 recovery (time to attain pain control and stable respiratory, haemodynamic, and neurological status). The analysis was by intention-to-treat. Of the 200 subjects randomised, 98 received sugammadex and 99 received neostigmine. There was no significant difference in the primary endpoint of postoperative pulmonary complications despite a signal towards reduced incidence for sugammadex (33% vs 40%; odds ratio [OR]=0.74; 95% confidence interval [CI]=[0.40, 1.37]; P=0.30) compared with neostigmine. Sugammadex decreased residual neuromuscular block (10% vs 49%; OR=0.11, 95% CI=[0.04, 0...Continue Reading

Associated Clinical Trials

References

Sep 30, 2004·Journal of the American College of Surgeons·Justin B DimickDarrell A Campbell
Oct 7, 2006·American Journal of Respiratory and Critical Care Medicine·Matthias EikermannJürgen Peters
Jun 19, 2008·British Journal of Anaesthesia·M EikermannN L Chamberlin
Jul 19, 2008·Anesthesia and Analgesia·Glenn S MurphyJeffery S Vender
Nov 4, 2010·Anesthesiology·Jaume CanetUNKNOWN ARISCAT Group
Nov 13, 2015·Anaesthesia·A Abad-GurumetaUNKNOWN Evidence Anaesthesia Review Group
Mar 6, 2016·The Kaohsiung Journal of Medical Sciences·Sedat HakimoğluSelim Turhanoğlu
Jul 2, 2016·Turkish Journal of Anaesthesiology and Reanimation·Dilek Yazıcıoğlu ÜnalOnur Özlü
Aug 9, 2016·Anesthesiology·Catherine M BulkaJesse M Ehrenfeld
Sep 19, 2018·The Lancet. Respiratory Medicine·Eva KirmeierUNKNOWN POPULAR Contributors
Feb 17, 2019·British Journal of Anaesthesia·Somnath BoseMatthias Eikermann

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Citations

Apr 2, 2020·British Journal of Anaesthesia·Karsten Bartels, Jennifer M Hunter
Sep 24, 2021·Anesthesiology·Kate LeslieDavid A Story
Oct 13, 2021·British Journal of Anaesthesia·Alexander F Arriaga
Oct 29, 2021·Anesthesiology·David LagierMarcos F Vidal Melo

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