• Indian J Anaesth · Jan 2013

    Introduction of sugammadex as standard reversal agent: Impact on the incidence of residual neuromuscular blockade and postoperative patient outcome.

    Reversal with sugammadex may reduce the incidence of post-operative residual paralysis and consequent morbidity.

    pearl
    • Thomas Ledowski, Samuel Hillyard, Brendan O'Dea, Rob Archer, Filipe Vilas-Boas, and Barney Kyle.
    • Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth WA, Australia ; School of Medicine and Pharmacology, the University of Western Australia, Perth WA, Australia.
    • Indian J Anaesth. 2013 Jan 1;57(1):46-51.

    BackgroundThe aim of this prospective audit was to investigate clinical practice related to muscle relaxant reversal and the impact made by the recent introduction of sugammadex on patient outcome at a tertiary teaching hospital.MethodsData from all patients intubated at our institution during two epochs of seven consecutive days each was collected prospectively. Directly prior to extubation, the train-of-four (TOF) ratio was assessed quantitatively by an independent observer. Postoperative outcome parameters were complications in the recovery room and radiological diagnosed atelectasis or pneumonia within 30 days.ResultsData from 146 patients were analysed. Three reversal strategies were used: no reversal, neostigmine or sugammadex. The TOF ratio was less than 0.7 in 17 patients (nine no reversal, eight neostigmine) and less than 0.9 in 47 patients (24 no reversal, 19 neostigmine, four sugammadex). Those reversed with sugammadex showed fewer episodes of postoperative oxygen desaturation (15% vs. 33%; P<0.05). TOF ratios of less than 0.7 (P<0.05) and also <0.9 (P<0.01) were more likely associated with X-ray results consistent with postoperative atelectasis or pneumonia.ConclusionsOur results suggest a significant impact of residual paralysis on patient outcome. The use of sugammadex resulted in the lowest incidence of residual paralysis.

      Pubmed     Free full text   Copy Citation     Plaintext  

      Add institutional full text...

    This article appears in the collections: Neuromuscular myths: the lies we tell ourselves and Is sugammadex as good as we think?.

    Notes

    pearl
    1

    Reversal with sugammadex may reduce the incidence of post-operative residual paralysis and consequent morbidity.

    Daniel Jolley  Daniel Jolley
    summary
    1

    An audit of pre-extubation residual paralysis before and after the introduction of sugammadex. Residual paralysis was significantly more common in those not reversed or reversed with neostigmine than in those reversed with sugammadex.

    Patients receiving sugammadex were also less likely to desaturate in the PACU and had fewer post-operative chest x-ray changes.

    Daniel Jolley  Daniel Jolley
     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…