• Ana B Serrano, Óscar DÍaz-Cambronero, Javier Melchor-RipollÉs, Alfredo Abad-Gurumeta, Jose M Ramirez-Rodriguez, Javier MartÍnez-Ubieto, Miriam SÁnchez-Merchante, Rita Rodriguez, Laura JordÁ, Silvia Gil-Trujillo, Mercedes Cabellos-Olivares, Daniel Bordonaba-Bosque, César Aldecoa, and POWER Group.
• Department of Anesthesiology, Ramón y Cajal University Hospital, Madrid, Spain - anab_serrano@yahoo.es.
• Minerva Anestesiol. 2021 Jan 1; 87 (1): 13-25.

BackgroundWe evaluated the impact of neuromuscular blockade (NMB) management, monitoring and reversal on postoperative outcomes in colorectal surgical patients included in an enhanced recovery program.MethodsWe performed a predefined analysis in 2084 patients undergoing elective colorectal surgery who participated in POWER study. We analyzed them for complications, length of hospital stay and mortality. Two groups were defined: 1) monitoring + reversal of the neuromuscular blockade (M+R) group: all patients receiving neuromuscular blockade monitoring plus reversal of it with any drug (neostigmine or sugammadex) were included; and 2) no monitoring nor reversal (noM+noR) group. In this group all the patients who did not receive monitoring and reversal of the neuromuscular blockade were allocated.ResultsMultivariate analysis found no statistically significant differences in moderate-severe complications (174 [25.7%] vs. 124 [27.1%]; P=0.607), length of hospital stay (10.8±11.1 vs. 11.0 ±12.6 days; P=0.683) and mortality (6 [0.9%] vs. 5 [1.1%]; P=0.840) between the group receiving optimal neuromuscular management (M+R) and the one did not receive it (noM+noR). Univariate analysis showed patients reversed with neostigmine died more than those reversed with sugammadex (3 [2.7%] vs. 3 [0.5%]; P=0.048).ConclusionsOur data suggest optimal neuromuscular blockade management in colorectal surgery is not associated with less moderate-severe complications, length of hospital stay or death during postoperative period in an enhanced recovery program. Neostigmine reversal seems to be linked to higher rate of mortality than sugammadex.

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