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Comparison of neostigmine vs. sugammadex for recovery of muscle function after neuromuscular block by means of diaphragm ultrasonography in microlaryngeal surgery: A randomised controlled trial.

Abstract

BACKGROUND

Postoperative residual neuromuscular blockade or curarisation (PORC) is a risk directly related to the use of neuromuscular blocking agents during surgical procedures. Acceleromyography is distressing for conscious patients when assessing PORC. Diaphragm ultrasonography could be a valid alternative.

OBJECTIVES

The primary objective was to achieve a 28% lower incidence of PORC in patients who, after rocuronium administration, received neostigmine or sugammadex at 30 min after surgery. To assess PORC, diaphragm ultrasonography was used, and thickening fractioning [the difference of thickness at the end of inspiration (TEI) and at the end of expiration (TEE), normalised for TEE (TEI - TEE/TEE)] was measured. PORC was defined as thickening fractioning of 0.36 or less. The secondary object was the comparison, in the two treatment groups, of the return to baseline thickening fractioning at 30 min after surgery (ΔTF30).

DESIGN

Prospective, double-blind, single-centre randomised study.

SETTING

University Hospital Careggi, Florence, Italy.

PATIENTS

Patients of American Society Anesthesiologists' physical status 1 or 2, 18 to 80 years, receiving rocuronium during microlaryngeal surgery.

INTERVENTIONS

At the end of surgery participants were randomised to receive neostigmine (NEO group) or sugammadex (SUG group) as the reversal drug. Thickening fractioning and ΔTF30 were evaluated at baseline and at 0, 10 and 30 min after surgery.

MAIN OUTCOME MEASURES

TEE and TEI at each time point.

RESULTS

A total of 59 patients with similar demographic characteristics were enrolled. An association between lack of recovery (thickening fractioning ≤0.36) and drug treatment was only observed at 0 min (SUG vs. NEO, P < 0.05). Concerning ΔTF, at 30 min more patients in the SUG group returned to baseline than those in the NEO group (P < 0.001), after adjusting for side (P = 0.52), baseline thickening fractioning (P < 0.0001) and time of measurement (P < 0.01).

CONCLUSION

We found an early (0 min) but not long-lasting (30 min) association between diaphragm failure and treatment allocation; a full recovery in baseline diaphragm function was observed only in patients receiving sugammadex. We cannot exclude that further differences have not been found due to interpatients variability in assessing diaphragm contractility by ultrasonography.

TRIAL REGISTRATION

EudraCT Identifier: 2013-004787-62, Clinicaltrials.gov Identifier: NCT02698969.

Authors+Show Affiliations

From the Department of Health Sciences, Azienda Ospedaliero Universitaria Careggi (IC, DO, BL, ARDG, CA) and Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy (LT).No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31356374

Citation

Cappellini, Iacopo, et al. "Comparison of Neostigmine Vs. Sugammadex for Recovery of Muscle Function After Neuromuscular Block By Means of Diaphragm Ultrasonography in Microlaryngeal Surgery: a Randomised Controlled Trial." European Journal of Anaesthesiology, 2019.
Cappellini I, Ostento D, Loriga B, et al. Comparison of neostigmine vs. sugammadex for recovery of muscle function after neuromuscular block by means of diaphragm ultrasonography in microlaryngeal surgery: A randomised controlled trial. Eur J Anaesthesiol. 2019.
Cappellini, I., Ostento, D., Loriga, B., Tofani, L., De Gaudio, A. R., & Adembri, C. (2019). Comparison of neostigmine vs. sugammadex for recovery of muscle function after neuromuscular block by means of diaphragm ultrasonography in microlaryngeal surgery: A randomised controlled trial. European Journal of Anaesthesiology, doi:10.1097/EJA.0000000000001055.
Cappellini I, et al. Comparison of Neostigmine Vs. Sugammadex for Recovery of Muscle Function After Neuromuscular Block By Means of Diaphragm Ultrasonography in Microlaryngeal Surgery: a Randomised Controlled Trial. Eur J Anaesthesiol. 2019 Jul 25; PubMed PMID: 31356374.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of neostigmine vs. sugammadex for recovery of muscle function after neuromuscular block by means of diaphragm ultrasonography in microlaryngeal surgery: A randomised controlled trial. AU - Cappellini,Iacopo, AU - Ostento,Daniele, AU - Loriga,Beatrice, AU - Tofani,Lorenzo, AU - De Gaudio,Angelo R, AU - Adembri,Chiara, Y1 - 2019/07/25/ PY - 2019/7/30/entrez PY - 2019/7/30/pubmed PY - 2019/7/30/medline JF - European journal of anaesthesiology JO - Eur J Anaesthesiol N2 - BACKGROUND: Postoperative residual neuromuscular blockade or curarisation (PORC) is a risk directly related to the use of neuromuscular blocking agents during surgical procedures. Acceleromyography is distressing for conscious patients when assessing PORC. Diaphragm ultrasonography could be a valid alternative. OBJECTIVES: The primary objective was to achieve a 28% lower incidence of PORC in patients who, after rocuronium administration, received neostigmine or sugammadex at 30 min after surgery. To assess PORC, diaphragm ultrasonography was used, and thickening fractioning [the difference of thickness at the end of inspiration (TEI) and at the end of expiration (TEE), normalised for TEE (TEI - TEE/TEE)] was measured. PORC was defined as thickening fractioning of 0.36 or less. The secondary object was the comparison, in the two treatment groups, of the return to baseline thickening fractioning at 30 min after surgery (ΔTF30). DESIGN: Prospective, double-blind, single-centre randomised study. SETTING: University Hospital Careggi, Florence, Italy. PATIENTS: Patients of American Society Anesthesiologists' physical status 1 or 2, 18 to 80 years, receiving rocuronium during microlaryngeal surgery. INTERVENTIONS: At the end of surgery participants were randomised to receive neostigmine (NEO group) or sugammadex (SUG group) as the reversal drug. Thickening fractioning and ΔTF30 were evaluated at baseline and at 0, 10 and 30 min after surgery. MAIN OUTCOME MEASURES: TEE and TEI at each time point. RESULTS: A total of 59 patients with similar demographic characteristics were enrolled. An association between lack of recovery (thickening fractioning ≤0.36) and drug treatment was only observed at 0 min (SUG vs. NEO, P < 0.05). Concerning ΔTF, at 30 min more patients in the SUG group returned to baseline than those in the NEO group (P < 0.001), after adjusting for side (P = 0.52), baseline thickening fractioning (P < 0.0001) and time of measurement (P < 0.01). CONCLUSION: We found an early (0 min) but not long-lasting (30 min) association between diaphragm failure and treatment allocation; a full recovery in baseline diaphragm function was observed only in patients receiving sugammadex. We cannot exclude that further differences have not been found due to interpatients variability in assessing diaphragm contractility by ultrasonography. TRIAL REGISTRATION: EudraCT Identifier: 2013-004787-62, Clinicaltrials.gov Identifier: NCT02698969. SN - 1365-2346 UR - https://www.unboundmedicine.com/medline/citation/31356374/Comparison_of_neostigmine_vs._sugammadex_for_recovery_of_muscle_function_after_neuromuscular_block_by_means_of_diaphragm_ultrasonography_in_microlaryngeal_surgery:_A_randomised_controlled_trial L2 - http://dx.doi.org/10.1097/EJA.0000000000001055 DB - PRIME DP - Unbound Medicine ER -