Department of Medicine, Anesthesiology and Intensive Care, University of Padova, Via C. Battisti, 267-35121, Padua, Italy,
Obes Surg. 2013 Oct;23(10):1558-63. doi: 10.1007/s11695-013-0926-y.
Morbidly obese (MO) patients are at increased risk for postoperative anesthesia-related complications. We evaluated the role of sugammadex versus neostigmine in the quality of recovery from profound rocuronium-induced neuromuscular blockade (NMB) in patients with morbid obesity.
We studied 40 female MO patients who received desflurane and remifentanil anesthesia for laparoscopic removal of adjustable gastric banding. NMB was achieved with rocuronium. At the end of the surgical procedure, complete reversal of NMB was obtained with sugammadex (SUG group, n = 20) or neostigmine plus atropine (NEO group, n = 20) in the presence of profound NMB.
No difference in surgical time or anesthetic drugs was found between the groups. Anesthesia time was significantly greater in the NEO group than in the SUG group (95 ± 21 vs. 47.9 ± 6.4 min, p < 0.0001), which was mainly due to a longer time to reach a train-of-four ratio (TOFR) ≥ 0.9 in the NEO group (48.6 ± 18 vs. 3.1 ± 1.3 min, p < 0.0001) during reversal of profound NMB. Upon admission to the postanesthesia care unit, level of SpO2 (p = 0.018), TOFR (p < 0.0001), ability to swallow (p = 0.0027), and ability to get into bed independently (p = 0.022) were better in the SUG group than in the NEO group. Patients in the SUG group were discharged to the surgical ward earlier than patients in the NEO group were (p = 0.013).
Sugammadex allowed a safer and faster recovery from profound rocuronium-induced NMB than neostigmine did in patients with MO. Sugammadex may play an important role in fast-track bariatric anesthesia.
病态肥胖（MO）患者术后麻醉相关并发症的风险增加。我们评估了在 MO 患者中，与新斯的明相比，琥珀酸舒更葡糖钠在罗库溴铵引起的深度神经肌肉阻滞（NMB）恢复质量中的作用。
我们研究了 40 名接受地氟醚和瑞芬太尼麻醉行腹腔镜可调胃束带切除术的女性 MO 患者。NMB 采用罗库溴铵诱导。在手术结束时，在深度 NMB 存在的情况下，使用琥珀酸舒更葡糖钠（SUG 组，n=20）或新斯的明加阿托品（NEO 组，n=20）获得 NMB 的完全逆转。
两组在手术时间或麻醉药物方面无差异。NEO 组的麻醉时间明显长于 SUG 组（95±21 分钟比 47.9±6.4 分钟，p<0.0001），这主要是由于 NEO 组在深度 NMB 逆转过程中达到四成比（TOFR）≥0.9 的时间更长（48.6±18 分钟比 3.1±1.3 分钟，p<0.0001）。在进入麻醉后护理单元时，SUG 组的 SpO2 水平（p=0.018）、TOFR（p<0.0001）、吞咽能力（p=0.0027）和独立上床能力（p=0.022）均优于 NEO 组。SUG 组的患者比 NEO 组更早出院到外科病房（p=0.013）。
与新斯的明相比，琥珀酸舒更葡糖钠在 MO 患者中可更安全、更快地从深度罗库溴铵诱导的 NMB 中恢复。琥珀酸舒更葡糖钠在肥胖患者的快速通道麻醉中可能发挥重要作用。
