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Operating room discharge after deep neuromuscular block reversed with sugammadex compared with shallow block reversed with neostigmine: a randomized controlled trial.
J Clin Anesth. 2016 Dec; 35:107-113.JC

Abstract

OBJECTIVE

To determine if reversing a deep or moderate block with sugammadex, compared with a shallow block reversed with neostigmine, reduces the time to operating room discharge after surgery and the time spent in the postanesthesia care unit.

DESIGN

A randomized controlled trial.

SETTING

Monocentric study performed from February 2011 until May 2012.

PATIENTS

One hundred consenting women with American Society of Anesthesiologists grade I or II were randomized into 2 groups.

INTERVENTION

Laparoscopic hysterectomy was performed under desflurane general anesthesia. For the neostigmine (N) group, 0.45 mg · kg-1 rocuronium was followed by spontaneous recovery. A 5-mg rescue bolus was administered only if surgical evaluation was unacceptable. At the end of surgery, 50 μg · kg-1 neostigmine with glycopyrrolate was administered. For the sugammadex (S) group, a higher intubating rocuronium dose (0.6 mg · kg-1) was followed by 5-mg boluses each time the train-of-four count exceeded 2. Sugammadex (2-4 mg · kg-1) was administered to reverse the block. All patients were extubated after obtaining a train-of-four ratio of 0.9.

MEASUREMENTS

The duration between the end of surgery and operating room discharge and the time spent in the postanesthesia care unit.

MAIN RESULTS

The time till operating room discharge was shorter and more predictable in group S (9.15±4.28 minutes vs 13.87±11.43 minutes in group N; P=.005). The maximal duration in group S was 22 minutes, compared with 72 minutes in group N. The time spent in the postanesthesia care unit was not significantly different (group S: 47.75±31.77 minutes and group N: 53.43±40.57 minutes; P=.543).

CONCLUSION

Maintaining a deep neuromuscular block during laparoscopic hysterectomy reversed at the end of the procedure with sugammadex enabled a faster and more predictable time till operating room discharge than did the classical combination of a shallower block reversed with neostigmine.

Authors+Show Affiliations

Anesthesiology Department, Université Catholique de Louvain, CHU UCL Namur, 1, Avenue Gaston Thérasse, B-5530 Yvoir, Belgium. Electronic address: laurie.putz@uclouvain.be.Anesthesiology Department, Université Catholique de Louvain, CHU UCL Namur, 1, Avenue Gaston Thérasse, B-5530 Yvoir, Belgium.Scientific Support Unit, Université Catholique de Louvain, CHU UCL Namur, 1, Avenue Gaston Thérasse, B-5530 Yvoir, Belgium.Gynecology Department, Université Catholique de Louvain, CHU UCL Namur, 1, Avenue Gaston Thérasse, B-5530 Yvoir, Belgium.Anesthesiology Department, Université Catholique de Louvain, CHU UCL Namur, 1, Avenue Gaston Thérasse, B-5530 Yvoir, Belgium.Anesthesiology Department, Université Catholique de Louvain, CHU UCL Namur, 1, Avenue Gaston Thérasse, B-5530 Yvoir, Belgium.

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

27871505

Citation

Putz, Laurie, et al. "Operating Room Discharge After Deep Neuromuscular Block Reversed With Sugammadex Compared With Shallow Block Reversed With Neostigmine: a Randomized Controlled Trial." Journal of Clinical Anesthesia, vol. 35, 2016, pp. 107-113.
Putz L, Dransart C, Jamart J, et al. Operating room discharge after deep neuromuscular block reversed with sugammadex compared with shallow block reversed with neostigmine: a randomized controlled trial. J Clin Anesth. 2016;35:107-113.
Putz, L., Dransart, C., Jamart, J., Marotta, M. L., Delnooz, G., & Dubois, P. E. (2016). Operating room discharge after deep neuromuscular block reversed with sugammadex compared with shallow block reversed with neostigmine: a randomized controlled trial. Journal of Clinical Anesthesia, 35, 107-113. https://doi.org/10.1016/j.jclinane.2016.07.030
Putz L, et al. Operating Room Discharge After Deep Neuromuscular Block Reversed With Sugammadex Compared With Shallow Block Reversed With Neostigmine: a Randomized Controlled Trial. J Clin Anesth. 2016;35:107-113. PubMed PMID: 27871505.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Operating room discharge after deep neuromuscular block reversed with sugammadex compared with shallow block reversed with neostigmine: a randomized controlled trial. AU - Putz,Laurie, AU - Dransart,Christophe, AU - Jamart,Jacques, AU - Marotta,Maria-Laura, AU - Delnooz,Geraldine, AU - Dubois,Philippe E, Y1 - 2016/08/10/ PY - 2016/04/15/received PY - 2016/06/07/revised PY - 2016/07/08/accepted PY - 2016/11/23/entrez PY - 2016/11/23/pubmed PY - 2017/8/12/medline KW - Neostigmine KW - Neuromuscular blockade KW - Recovery room KW - Rocuronium KW - Sugammadex SP - 107 EP - 113 JF - Journal of clinical anesthesia JO - J Clin Anesth VL - 35 N2 - OBJECTIVE: To determine if reversing a deep or moderate block with sugammadex, compared with a shallow block reversed with neostigmine, reduces the time to operating room discharge after surgery and the time spent in the postanesthesia care unit. DESIGN: A randomized controlled trial. SETTING: Monocentric study performed from February 2011 until May 2012. PATIENTS: One hundred consenting women with American Society of Anesthesiologists grade I or II were randomized into 2 groups. INTERVENTION: Laparoscopic hysterectomy was performed under desflurane general anesthesia. For the neostigmine (N) group, 0.45 mg · kg-1 rocuronium was followed by spontaneous recovery. A 5-mg rescue bolus was administered only if surgical evaluation was unacceptable. At the end of surgery, 50 μg · kg-1 neostigmine with glycopyrrolate was administered. For the sugammadex (S) group, a higher intubating rocuronium dose (0.6 mg · kg-1) was followed by 5-mg boluses each time the train-of-four count exceeded 2. Sugammadex (2-4 mg · kg-1) was administered to reverse the block. All patients were extubated after obtaining a train-of-four ratio of 0.9. MEASUREMENTS: The duration between the end of surgery and operating room discharge and the time spent in the postanesthesia care unit. MAIN RESULTS: The time till operating room discharge was shorter and more predictable in group S (9.15±4.28 minutes vs 13.87±11.43 minutes in group N; P=.005). The maximal duration in group S was 22 minutes, compared with 72 minutes in group N. The time spent in the postanesthesia care unit was not significantly different (group S: 47.75±31.77 minutes and group N: 53.43±40.57 minutes; P=.543). CONCLUSION: Maintaining a deep neuromuscular block during laparoscopic hysterectomy reversed at the end of the procedure with sugammadex enabled a faster and more predictable time till operating room discharge than did the classical combination of a shallower block reversed with neostigmine. SN - 1873-4529 UR - https://www.unboundmedicine.com/medline/citation/27871505/Operating_room_discharge_after_deep_neuromuscular_block_reversed_with_sugammadex_compared_with_shallow_block_reversed_with_neostigmine:_a_randomized_controlled_trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0952-8180(16)30425-1 DB - PRIME DP - Unbound Medicine ER -