Key result
Sugammadex significantly increased the probability of achieving a full reversal of neuromuscular blockade (TOF >0.9) compared to neostigmine (83% vs 49%, OR 4.61) in patients over 65 years of age.
Why the study?
Postoperative residual curarisation may be linked to complications following general anaesthesia, particularly in patients older than 65 years, but neuromuscular monitoring remains non-standard.
Does sugammadex reduce postoperative residual curarisation and critical respiratory events compared to neostigmine in patients over 65 years of age undergoing general anaesthesia?
Observational (n=351)
Single-blind
No
Does sugammadex reduce postoperative residual curarisation and critical respiratory events compared to neostigmine in patients over 65 years of age undergoing general anaesthesia?
Odds Ratio: 4.61 (95% CI 2.89–7.34)
Absolute Event Rate: 83% vs 49%
p-value: p=<0.001
In elderly patients undergoing general anaesthesia, sugammadex effectively prevents postoperative residual curarisation and significantly reduces the incidence of critical respiratory events compared to neostigmine.
May support sugammadex preference for reversal in patients >65; hypothesis-generating and requires randomized confirmation before practice change.
Background. Neuromuscular blocking drugs have contributed to advances in anaesthesiology. The first agent blocking neuromuscular transmission was curare. Alarming respiratory complications in patients recovering from anaesthesia were reported from the very beginning of curare use. The currently used non-depolarizing muscle relaxants are regarded as safe. However, postoperative residual curarisation may be associated with the risk of complications in the first few days after general anaesthesia, especially in patients older than 65 years. This study aims to investigate the effect of sugammadex on the incidence of postoperative residual curarisation, postoperative critical respiratory events, and postoperative cognitive dysfunction. Although recommended, neuromuscular monitoring is still not standard practice during general anaesthesia with the use of muscle relaxants. Methods. Overall, 351 patients aged 65-91 years were included in the observational study. Patients were anaesthetised at the M. Kopernik Provincial Multispeciality Centre of Oncology and Traumatology in Lodz. Spirometry and MMSE (Mini-Mental State Examination) were performed in patients one day before the surgery and one day postoperatively. Neuromuscular blockade was not monitored intraoperatively. One measurement was taken during recovery from anaesthesia. Anaesthetists made a decision to administer either a dose of 2mg/kg sugammadex (group S) or 0.05 mg/kg of neostigmine iv (group N) during recovery from anaesthesia. Results. There were significant differences (p<0.001) between the groups in postoperative TOF ratios. The percentage of patients with TOF ratios >0.9 was significantly higher in the S group than in the N group (83% vs 49%). The incidence of critical respiratory events was significantly lower in the S group compared to the N group (7.6% vs 17%). The study demonstrated significant differences in the postoperative scores of MMSE. Conclusions. Sugammadex effectively prevents postoperative residual curarisation in patients over the age of 65. It reduces the incidence of critical respiratory events in elderly patients. The study revealed a slight trend that full reversal of the neuromuscular blockade may correspond with the improvement of postoperative cognitive functions. Trial registration: Trial ID: ISRCTN17481425 Date registered: 27/01/2020, Link: https://www.isrctn.com/ISRCTN17481425
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Pietraszewski et al. (2020) conducted an observational in Postoperative residual curarisation (n=351). Sugammadex vs. Neostigmine 0.05 mg/kg was evaluated on Postoperative TOF ratio > 0.9 at PACU (OR 4.61, 95% CI 2.89-7.34, p=<0.001). Sugammadex significantly increased the probability of achieving a full reversal of neuromuscular blockade (TOF >0.9) compared to neostigmine (83% vs 49%, OR 4.61) in patients over 65 years of age.
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