Ünal Dilek Yazıcıoğlu, Baran İlkay, Mutlu Murad, Ural Gülçin, Akkaya Taylan, Özlü Onur
Clinic of Anaesthesiology and Reanimation, Ministry Health Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.
Clinic of Otorhinolaryngology, Ministry Health Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.
Turk J Anaesthesiol Reanim. 2015 Dec;43(6):387-95. doi: 10.5152/TJAR.2015.35682. Epub 2015 Dec 1.
To compare sugammadex and neostigmine regarding the efficacy in reversing rocuronium-induced neuromuscular block, the incidence of post-operative respiratory complications and costs in patients undergoing surgery for the treatment of obstructive sleep apnoea (OSA).
After obtaining ethical approval and patient consent, 74 patients in ASA physical status I or II were randomised into two groups to receive 2-mg kg(-1) sugammadex (Group S) or 0.04-mg kg(-1) neostigmine+0.5-mg atropine (Group N). Groups were compared regarding time to TOF (train-of-four) 0.9, operating room time, post-anaesthesia care unit (PACU) stay, post-operative respiratory complications, costs related to neuromuscular block reversal, anaesthesia care and complication treatment.
Patient demographics, anaesthesia, surgical data and total rocuronium doses were similar between groups. Time to TOF 0.9 was shorter for group S [Group N: 8 (5-18) min; Group S: 2 (1.5-6) min (p<0.001)]. Operating room time [Group S: 72.4±14.3 min; Group N: 96.6±22.8 min (p<0.001)] and PACU stay [Group S: 22.9±10.1 dk; Group N: 36.3±12.6 dk (p<0.001)] were also shorter in Group S. After extubation, desaturation was observed in 12 (32.4%) patients in group N and in 4 (8%) patients in group S (p=0.048). In group N, three patients were reintubated; there were eight (21.6%) unplanned intensive care unit (ICU) admissions. There was one unplanned ICU admission in group S. Negative pressure pulmonary oedema was observed in one patient in group N. The results regarding costs were as follows. The reversal cost was higher in the sugammadex group (vial cost 98.14 TL) than that in the neostigmine group (ampoule cost 0.27 TL; total 6147.88 TL vs. 3569.5 TL); however, complication treatment cost and total cost were lower in group S than those in group N (199.5 TL vs. 3944.6 TL) (staff anaesthesia doctor cost was 0.392 TL per min and the cost of nurse anaesthetist was 0.244 TL per min).
This study confirmed the efficacy of sugammadex over neostigmine for the reversal of rocuronium-induced neuromuscular block. Sugammadex decreases the incidence of post-operative respiratory complications and related costs in patients with OSA.
比较舒更葡糖钠与新斯的明在逆转罗库溴铵诱导的神经肌肉阻滞方面的疗效、阻塞性睡眠呼吸暂停（OSA）手术患者术后呼吸并发症的发生率及成本。
获得伦理批准并征得患者同意后，将74例ASA身体状况为I或II级的患者随机分为两组，分别接受2mg/kg的舒更葡糖钠（S组）或0.04mg/kg的新斯的明+0.5mg阿托品（N组）。比较两组达到四个成串刺激（TOF）比值0.9的时间、手术室时间、麻醉后监护病房（PACU）停留时间、术后呼吸并发症、神经肌肉阻滞逆转相关成本、麻醉护理及并发症治疗成本。
两组患者的人口统计学资料、麻醉、手术数据及罗库溴铵总剂量相似。S组达到TOF比值0.9的时间更短[N组：8（5-18）分钟；S组：2（1.5-6）分钟（p<0.001）]。S组的手术室时间[S组：72.4±14.3分钟；N组：96.6±22.8分钟（p<0.001）]和PACU停留时间[S组：22.9±10.1分钟；N组：36.3±12.6分钟（p<0.001）]也更短。拔管后，N组12例（32.4%）患者出现低氧血症，S组4例（8%）患者出现低氧血症（p=0.048）。N组有3例患者再次插管；有8例（21.6%）患者非计划入住重症监护病房（ICU）。S组有1例患者非计划入住ICU。N组1例患者出现负压性肺水肿。成本结果如下。舒更葡糖钠组的逆转成本高于新斯的明组（小瓶成本98.14土耳其里拉）（安瓿成本0.27土耳其里拉；总计6147.88土耳其里拉对3569.5土耳其里拉）；然而，S组的并发症治疗成本和总成本低于N组（199.5土耳其里拉对3944.6土耳其里拉）（麻醉医生成本为每分钟0.392土耳其里拉，麻醉护士成本为每分钟0.244土耳其里拉）。
本研究证实舒更葡糖钠在逆转罗库溴铵诱导的神经肌肉阻滞方面优于新斯的明。舒更葡糖钠可降低OSA患者术后呼吸并发症的发生率及相关成本。
