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October 24, 2015
3:15:00 PM - 5:15:00 PM
Room Hall B2-Area C
A Comparison of Effects on Respiratory Function of Sugammadex and Neostigmine in the Reversal of Moderate Rocuronium-induced Neuromuscular Blockade
Daisuke Arashi, M.D., Ryu Okutani, M.D.
Osaka City General Hospital, Osaka, Japan
Disclosures: D. Arashi: None. R. Okutani: None.
Background: Sugammadex has been shown to reduce the risk of residual muscle relaxant and postoperative respiratory complications. An experimental study reported that sugammadex slightly reduces tidal volume and minute volume in the reversal of rocuronium-induced blockade, unlike neostigmine. However, this comparison has not been performed in human clinical trials. We therefore investigated changes in forced vital capacity (FVC) and forced expiratory volume in one second (FEV1.0) after administration of sugammadex and neostigmine in a random controlled trial.

Methods: All patients who provided written informed consent and were to undergo elective laparoscopic colorectal surgery were randomly assigned to sugammadex or neostigmine treatment. Before anesthesia, an epidural catheter was inserted at a level between Th9 and Th12. Subsequently, anesthesia was induced with 1-2 mg/kg propofol and 2-4 µg/kg fentanyl, with 0.9 mg/kg rocuronium administered and tracheal intubation performed. They were maintained with sevoflurane (target BIS 50) in oxygen and air. Intraoperative analgesia was obtained by continuous epidural injection of 1.5% lidocaine (4-10ml). Neuromuscular blockade was assessed using an acceleromyograph (S/5 E-NMT®, GE Healthcare CO, Tokyo, Japan), with train-of-four (TOF) stimulation at the adductor pollicis muscle. Rocuronium was continuously administered (target TOF count 1). Sugammadex (2 mg/kg) or neostigmine (2mg) was given after surgery. We analyzed the time until extubation, recovery of TOF ratio and respiratory function. TOF ratio was measured five minutes and twenty minutes later after reversal of neuromuscular blockade. FVC and FEV1.0 were also measured before induction of anesthesia and twenty minutes later after reversal using spirometry (HI-205®, Nihon Kohden Co, Tokyo, Japan). Findings of P<0.05 were considered significant, and values are expressed as the mean±SD.

Results: thirty-six patients were enrolled in this study, and were divided into eighteen patients receiving sugammadex and eighteen receiving neostigmine. There were no relevant differences in patient characteristics between groups. Our results were shown in table 1. The recovery of TOF ratio five minutes and twenty minutes later after reversal was greater in patients who had received sugammadex than those who had received neostigmine. Furthermore, the time until extubation was shorter in the sugammadex group than the neostigmine group. FVC and FEV1.0 decreased significantly after the procedure in each group. Although there were no significant differences between groups in postoperative decrements of FEV1.0, the sugammadex group had a smaller decrement than the neostigmine group in FVC. There were no patients suffering from severe respiratory complications in the postoperative period.

Conclusion: We find significant differences between sugammadex and neostigmine in the recovery of TOF and FVC. Our findings probably suggest that sugammadex is greater than neostigmine in not only skeletal muscles recovery but also respiratory muscles recovery. However, there were no significant differences in FEV1.0. We consider that sugammadex is greater in continuous respiratory muscles recovery.

Figure 1

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