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comment
1
This study is important because it looked specifically at patients with COPD, whereas most studies to date (showing somewhat conflicting evidence on the benefit or not of regional anesthesia to perioperative mortality & morbidity) have looked at more general patient populations.
Hausman MS, Jewell ES, Engoren M. Regional Versus General Anesthesia in Surgical Patients with Chronic Obstructive Pulmonary Disease: Does Avoiding General Anesthesia Reduce the Risk of Postoperative Complications? Anesth. Analg. 2015 Jun 1; 120 (6): 1405-12.
  Daniel Jolley
pearl
1
In patients with chronic obstructive pulmonary disease, use of regional anesthesia is associated with less post-operative morbidity, though not mortality, when compared with general anesthesia.
Hausman MS, Jewell ES, Engoren M. Regional Versus General Anesthesia in Surgical Patients with Chronic Obstructive Pulmonary Disease: Does Avoiding General Anesthesia Reduce the Risk of Postoperative Complications? Anesth. Analg. 2015 Jun 1; 120 (6): 1405-12.
  Daniel Jolley
pearl
1
Negative post-anesthetic cognitive effects are still present one week after both desflurane or propofol anesthesia.
Lindqvist M, Schening A, Granstrom A et al. Cognitive recovery after ambulatory anaesthesia based on desflurane or propofol: a prospective randomised study. Acta Anaesthesiol Scand. 2014 Oct 1;58(9):1111-20.
  Daniel Jolley
pearl
1
Unrestricted access to sugammadex both increases the use of sugammadex and changes patterns of muscle relaxant drug choice by anaesthetists.
Watts RW, London JA, van RM et al. The influence of unrestricted use of sugammadex on clinical anaesthetic practice in a tertiary teaching hospital. Anaesth Intensive Care. 2012 Mar 1;40(2):333-9.
  Daniel Jolley
comment
0
The actual cost of both operating theatre and recovery room time in the U.S., Canada, Australia and greater Europe is likely much, much higher than figures used by the researchers. Thus even at its current high cost there is a strong economic argument to be made for using sugammadex for routine reversal.
However, the opposing point is that the economic benefit is only real if the liberated operating room time can actually be utilised for productive surgical work – this is currently unlikely in many hospitals due to inefficient and inflexible scheduling.
Paton F, Paulden M, Chambers D et al. Sugammadex compared with neostigmine/glycopyrrolate for routine reversal of neuromuscular block: a systematic review and economic evaluation. Br J Anaesth. 2010 Nov 1;105(5):558-67.
  Daniel Jolley
comment
0
As the evidence-base increases and the cost falls, it will be indications #2 and #4 that carry our shift in practice to using sugammadex and its successors. We will recognise larger groups of patients for whom residual paralysis is detrimental (everyone?) while simultaneously appreciating better how common the problem truly is.
Gibbs NM Kam PC. Sugammadex: restricted vs unrestricted or selective vs non-selective? Anaesth Intensive Care. 2012 Mar 1;40(2):213-5.
  Daniel Jolley
pearl
1
Sugammadex is superior to neostigmine for reversal of rocuronium neuromuscular blockade.
Abrishami A, Ho J, Wong J et al. Sugammadex, a selective reversal medication for preventing postoperative residual neuromuscular blockade. Cochrane Db Syst Rev. 2009 Jan 1(4):CD007362.
  Daniel Jolley
pearl
1
Reversal with sugammadex is 10 times faster than with neostigmine and three times faster than with edrophonium.
Sacan O, White PF, Tufanogullari B et al. Sugammadex reversal of rocuronium-induced neuromuscular blockade: a comparison with neostigmine-glycopyrrolate and edrophonium-atropine. Anesth. Analg. 2007 Mar 1;104(3):569-74.
  Daniel Jolley
comment
0
Sugammadex is a great drug, but not a universal magic bullet.
Kyle BC, Gaylard D, Riley RH. A persistent 'can't intubate, can't oxygenate' crisis despite rocuronium reversal with sugammadex. Anaesth Intensive Care. 2012 Mar 1;40(2):344-6.
  Daniel Jolley
pearl
1
Adequate reversal of neuromuscular blockade may not always be helpful when successfully managing a cannot intubate-cannot-ventilate crisis.
Kyle BC, Gaylard D, Riley RH. A persistent 'can't intubate, can't oxygenate' crisis despite rocuronium reversal with sugammadex. Anaesth Intensive Care. 2012 Mar 1;40(2):344-6.
  Daniel Jolley