Sugammadex significantly lowered the area under the curve of middle cerebral artery velocity relative to baseline compared to neostigmine during emergence from anesthesia (24,600 vs 31,575; p=0.044).
RCT (n=82)
Double-blind
1:1 ratio
No
Does sugammadex reduce excessive cerebral blood flow during emergence from general anesthesia in patients undergoing carotid endarterectomy compared to neostigmine?
Sugammadex is superior to neostigmine in reversing neuromuscular blockade during emergence from general anesthesia in CEA patients, as it reduces excessive cerebral blood flow and shortens extubation time.
Effect estimate: Estimate -10896 (95% CI -21387 to -405)
Absolute Event Rate: 24600% vs 31575%
p-value: p=0.044
ABSTRACT Background Carotid endarterectomy (CEA) is the standard treatment for carotid stenosis, but has the risk of cerebral hyperperfusion syndrome (CHS). Postoperative residual neuromuscular blockade can trigger cerebral hyperperfusion (CH), and the effects of neostigmine and sugammadex on cerebral perfusion during CEA are unclear. Objective This study aimed to compare the efficacy of neostigmine combined with atropine and sugammadex in reversing neuromuscular blockade in CEA patients under general anesthesia and evaluate the superiority of sugammadex in maintaining normal cerebral perfusion during anesthesia emergence. Methods A single‐center, prospective, randomized controlled study was carried out and registered on the Chinese Clinical Trial Registry website (ChiCTR2300078579). Between December 2023 and June 2024, 90 patients were recruited. After exclusions, 82 patients were randomly assigned to the sugammadex group or the neostigmine group at a 1:1 ratio. The primary outcome was the difference in the area under the curve of the percentage of middle cerebral artery velocity relative to baseline (MCAV% S) during emergence. Secondary outcomes included multiple hemodynamic and clinical parameters, as well as pulmonary and CH‐related complications within 48 h post‐operation. Mediation analysis, ROC analysis, and multivariate linear regression analysis were used to illustrate the differences in MCAV%S between the two groups and subsequent analysis. Results The MCAV% S in the sugammadex group was significantly lower than in the neostigmine group (24,600 14,940–38,040 vs. 31,575 24,210–50,040, p = 0.044), and this difference persisted after adjusting for variables (Estimate (95% CI): −10,896 −21,387 ~ −405; p = 0.042). The sugammadex group had shorter eye‐opening and extubation times, and a lower incidence of hypoxemia and overall pulmonary complication score. Mediation analysis showed that extubation time mediated part of the effect on MCAV% S, and the ROC analysis indicated good predictive performance of MCAV% S for CH. Conclusion In CEA patients, sugammadex is more advantageous than neostigmine in reversing neuromuscular blockade during emergence, as it shortens extubation time, reduces excessive cerebral blood flow, and potentially lowers the incidence of postoperative complications.
Jia et al. (Fri,) conducted a rct in Carotid stenosis undergoing carotid endarterectomy (n=82). Sugammadex vs. Neostigmine combined with atropine was evaluated on Area under the curve of the percentage of middle cerebral artery velocity relative to baseline (MCAV% S) during emergence (Estimate -10896, 95% CI -21387 to -405, p=0.044). Sugammadex significantly lowered the area under the curve of middle cerebral artery velocity relative to baseline compared to neostigmine during emergence from anesthesia (24,600 vs 31,575; p=0.044).