OUTCOMES OF POSTOPERATIVE RESIDUAL NEUROMUSCULAR BLOCKADE: COMPARISON BETWEEN SUGAMMADEX AND NEOSTIGMINE
Abstract
INTRODUCTION: Residual Neuromuscular Blockade is due to incomplete antagonism of Neuromuscular Blockade (NMB) medications. A train of four (TOF) ratios of 0.9 and above is indicative of adequate reversal from NMB. Also it has been shown that, in postoperative period, risk of aspiration would be increased by additional inhibitory effects of residual inhalational anaesthetics, by depressed conscious level on pharyngeal and laryngeal function. Silent aspiration may cause postoperative pneumonia. Especially in elderly patients who are partially paralyzed after anesthesia, pharyngeal secretion is likely to be retained and there may be bacterial overgrowth. The retained secretion may then be aspirated to the laryngeal inlet, predisposing to silent aspiration-induced pneumonia. So assurance of complete reversal of neuromuscular blockade may reduce the incidence of postoperative aspiration-induced pneumonia, together with other respiratory complications.
MATERIAL AND METHODS: Patients included were from the age range of 18 to 65 years who were cheduled to undergo elective surgery during general anesthesia in the supine position. An intravenous cannula was inserted into one forearm vein for routine anesthetic and study drug administration. Another intravenous cannula was inserted into the opposite arm for blood sampling for safety analysis. The anesthetic agents and doses were adjusted to give support and anesthesia was appropriately maintained until recovery of neuromuscular function to a TOF ratio of 0.9. Two drugs were used for reversal of NMB, sugammadex and neostigmine. Blood samples were collected 4hours after administration of sugammadex or neostigmine, for assessments of blood counts and biochemistry. Urine samples, collected up to 24 h preoperatively were assessed for standard urinalysis.
RESULTS: A total of 100 subjects were included in the study 50 insugammadex and 50 in neostigmine in each arm. In Sugammadex group there were 50 patients of which 21(42%) were male and 29(58%) were female. As per ASA, in Sugammadex group 5 (10%), 34 (68%) and 1 (22%) were in ASA Physical status I, status II and Status III respectively and in Neostigmine group 4 (8%), 31 (62%) and 15 (30%) were in ASA Physical status I, status II and Status III respectively. There was faster time to recovery in sugammadex group. Most sugammadexpatients 34 (68%) recovered within 3 min of administration of drug, and all recovered within 5 min. Most neostigmine patients 39 (78%) recovered 30–60 min after administration, with 22% taking more than one hour to achieve a TOF ratio of 0.9.
CONCLUSION: Profound neuromuscular blockade can be rapidly and reliably reversed by sugammadex in patients and sugammadex also provides a more rapid reversal of neuromuscular blockade than neostigmine.
