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Comparison of recovery after sugammadex or neostigmine reversal of rocuronium in geriatric patients undergoing spine surgery: a randomized controlled trial.
Croat Med J. 2021 Dec 31; 62(6):606-613.CM

Abstract

AIM

To evaluate the effect of sugammadex compared with neostigmine on speed and quality of recovery after rocuronium neuromuscular blockade (NMB) in geriatric patients undergoing posterior lumbar spine surgery.

METHODS

This randomized controlled study at a tertiary academic medical center involved 40 patients (age ≥65 years, ASA PS II/III) scheduled for elective surgery under general anesthesia. Patients were randomized to sugammadex or neostigmine for reversal of moderate NMB with rocuronium. The primary outcome was recovery time from NMB after surgery to a train-of-four (TOF) ratio ≥0.9 measured at the adductor pollicis (TOF-Watch® SX). Secondary outcomes included hemodynamic change after administration of reversal agent (heart rate, blood pressure, dysrhythmia), time to extubation, pain medication requirement, time to first ambulation, and length of postanesthesia care unit (PACU) and total hospital stay.

RESULTS

Sugammadex (4±2.2 min) compared with neostigmine reversal (26.3±17.5 min) was on average 22 min faster (95% CI 14.1-30.5; P≤0.001) with less variability (range 2-11 min vs 5-72 min). The groups significantly differed in time for tracheal extubation, response to verbal commands (open eyes, squeeze hand, lift head), and operating room exit. However, they had similar PACU stay, time to first ambulation, total hospital stay, postoperative pain, and opioid use. Sugammadex had less hemodynamic variability than neostigmine. No patient developed treatment-emergent dysrhythmias.

CONCLUSION

Sugammadex reversal significantly hastened NMB recovery compared with neostigmine reversal in geriatric patients. It significantly decreased operating room time but not PACU time or hospital stay.

Links

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Authors+Show Affiliations

Mraovic B
Boris Mraovic, Department of Anesthesiology and Perioperative Medicine, School of Medicine, University of Missouri-Columbia, One Hospital Dr., DC005.00 Columbia, MO 65212, mraovicb@health.missouri.edu.
Timko NJ
No affiliation info available
Choma TJ
No affiliation info available

MeSH

AgedHumansNeostigmineNeuromuscular BlockadeNeuromuscular Nondepolarizing AgentsRocuroniumSugammadex

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

34981693

Clinical Trial Links

Speed of Recovery of Reversal of Neuromuscular Blockade in Geriatric Patients Undergoing Spine Surgery

Citation

Mraovic, Boris, et al. "Comparison of Recovery After Sugammadex or Neostigmine Reversal of Rocuronium in Geriatric Patients Undergoing Spine Surgery: a Randomized Controlled Trial." Croatian Medical Journal, vol. 62, no. 6, 2021, pp. 606-613.
Mraovic B, Timko NJ, Choma TJ. Comparison of recovery after sugammadex or neostigmine reversal of rocuronium in geriatric patients undergoing spine surgery: a randomized controlled trial. Croat Med J. 2021;62(6):606-613.
Mraovic, B., Timko, N. J., & Choma, T. J. (2021). Comparison of recovery after sugammadex or neostigmine reversal of rocuronium in geriatric patients undergoing spine surgery: a randomized controlled trial. Croatian Medical Journal, 62(6), 606-613.
Mraovic B, Timko NJ, Choma TJ. Comparison of Recovery After Sugammadex or Neostigmine Reversal of Rocuronium in Geriatric Patients Undergoing Spine Surgery: a Randomized Controlled Trial. Croat Med J. 2021 Dec 31;62(6):606-613. PubMed PMID: 34981693.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of recovery after sugammadex or neostigmine reversal of rocuronium in geriatric patients undergoing spine surgery: a randomized controlled trial. AU - Mraovic,Boris, AU - Timko,Noah J, AU - Choma,Theodore J, PY - 2022/1/4/entrez PY - 2022/1/5/pubmed PY - 2022/1/6/medline SP - 606 EP - 613 JF - Croatian medical journal JO - Croat Med J VL - 62 IS - 6 N2 - AIM: To evaluate the effect of sugammadex compared with neostigmine on speed and quality of recovery after rocuronium neuromuscular blockade (NMB) in geriatric patients undergoing posterior lumbar spine surgery. METHODS: This randomized controlled study at a tertiary academic medical center involved 40 patients (age ≥65 years, ASA PS II/III) scheduled for elective surgery under general anesthesia. Patients were randomized to sugammadex or neostigmine for reversal of moderate NMB with rocuronium. The primary outcome was recovery time from NMB after surgery to a train-of-four (TOF) ratio ≥0.9 measured at the adductor pollicis (TOF-Watch® SX). Secondary outcomes included hemodynamic change after administration of reversal agent (heart rate, blood pressure, dysrhythmia), time to extubation, pain medication requirement, time to first ambulation, and length of postanesthesia care unit (PACU) and total hospital stay. RESULTS: Sugammadex (4±2.2 min) compared with neostigmine reversal (26.3±17.5 min) was on average 22 min faster (95% CI 14.1-30.5; P≤0.001) with less variability (range 2-11 min vs 5-72 min). The groups significantly differed in time for tracheal extubation, response to verbal commands (open eyes, squeeze hand, lift head), and operating room exit. However, they had similar PACU stay, time to first ambulation, total hospital stay, postoperative pain, and opioid use. Sugammadex had less hemodynamic variability than neostigmine. No patient developed treatment-emergent dysrhythmias. CONCLUSION: Sugammadex reversal significantly hastened NMB recovery compared with neostigmine reversal in geriatric patients. It significantly decreased operating room time but not PACU time or hospital stay. SN - 1332-8166 UR - https://www.unboundmedicine.com/medline/citation/34981693/Comparison_of_recovery_after_sugammadex_or_neostigmine_reversal_of_rocuronium_in_geriatric_patients_undergoing_spine_surgery:_a_randomized_controlled_trial_ DB - PRIME DP - Unbound Medicine ER -