Key result
Pharmacological reversal of rocuronium with sugammadex significantly reduced the incidence of residual neuromuscular blockade to 5.33% compared to 35.87% with spontaneous reversal.
Why the study?
Controversy exists over whether intraoperative pharmacological reversal of neuromuscular blockade reduces postoperative residual neuromuscular blockade or pulmonary complications.
Does pharmacological reversal of neuromuscular blockade and intraoperative neuromuscular monitoring reduce postoperative residual neuromuscular blockade and pulmonary complications in patients undergoing general anesthesia?
Cohort (n=714)
Single-blind (research staff measuring TOF blinded)
No
Does pharmacological reversal of neuromuscular blockade and intraoperative neuromuscular monitoring reduce postoperative residual neuromuscular blockade and pulmonary complications in patients undergoing general anesthesia?
Absolute Event Rate: 5.33% vs 35.87%
p-value: p=<0.001
Intraoperative neuromuscular monitoring and pharmacological reversal of rocuronium with sugammadex significantly reduce the risk of residual neuromuscular blockade and postoperative pulmonary complications.
Sugammadex reversal with monitoring was associated with lower residual blockade and pulmonary complications; leaves open causal effects pending randomized trials.
In recent years, some studies have generated controversy since they conclude that intraoperatively pharmacological reversal of neuromuscular blockade does not contribute to the reduction of postoperative residual neuromuscular blockade or pulmonary complications. Therefore, the main objective of this study was to assess the incidence of residual neuromuscular blockade and postoperative pulmonary complications according to spontaneous or pharmacological neuromuscular reversal. The secondary aim was to present a prognostic model to predict the probability of having postoperative residual neuromuscular blockade depending on a patient's comorbidities and intraoperative neuromuscular blocking agents management. A single-center, prospective, observational cohort study including patients undergoing surgical procedures with general anesthesia was designed. A total of 714 patients were analyzed. Patients were divided into four groups: cisatracurium with spontaneous reversal, cisatracurium with neostigmine antagonism, rocuronium with spontaneous reversal, and rocuronium with sugammadex antagonism. According to our binomial generalized linear model, none of the studied comorbidities was a predisposing factor for an increase in the residual neuromuscular blockade. However, in our study, pharmacological reversal of rocuronium with sugammadex and, particularly, neuromuscular monitoring during surgery were the factors that most effectively reduced the risk of residual neuromuscular blockade as well as early and late postoperative pulmonary complications.
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Aragón‐Benedí et al. (2022) conducted a cohort in Patients undergoing surgical procedures with general anesthesia and neuromuscular blocking agents (n=714). Rocuronium with sugammadex antagonism vs. Rocuronium without pharmacological reversal was evaluated on Postoperative residual neuromuscular blockade (TOF ratio < 0.9 at PACU admission) (p=<0.001). Pharmacological reversal of rocuronium with sugammadex significantly reduced the incidence of residual neuromuscular blockade to 5.33% compared to 35.87% with spontaneous reversal.
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