Suleiman A, Munoz-Acuna R, Azimaraghi O, Houle T T, Chen G, Rupp S, Witt A S, Azizi B A, Ahrens E, Shay D, Wongtangman K, Wachtendorf L J, Tartler T M, Eikermann M, Schaefer M S
Department of Anesthesia, Critical Care and Pain Medicine, Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, MA, Boston, USA.
Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, NY, Bronx, USA.
Anaesthesia. 2023 Mar;78(3):294-302. doi: 10.1111/anae.15940. Epub 2022 Dec 23.
Reversing neuromuscular blockade with sugammadex can eliminate residual paralysis, which has been associated with postoperative respiratory complications. There are equivocal data on whether sugammadex reduces these when compared with neostigmine. We investigated the association of the choice of reversal drug with postoperative respiratory complications and advanced healthcare utilisation. We included adult patients who underwent surgery and received general anaesthesia with sugammadex or neostigmine reversal at two academic healthcare networks between January 2016 and June 2021. The primary outcome was postoperative respiratory complications, defined as post-extubation oxygen saturation < 90%, respiratory failure requiring non-invasive ventilation, or tracheal re-intubation within 7 days. Our main secondary outcome was advanced healthcare utilisation, a composite outcome including: 7-day unplanned intensive care unit admission; 30-day hospital readmission; or non-home discharge. In total, 5746 (6.9%) of 83,250 included patients experienced postoperative respiratory complications. This was not associated with the reversal drug (adjusted OR (95%CI) 1.01 (0.94-1.08); p = 0.76). After excluding patients admitted from skilled nursing facilities, 8372 (10.5%) patients required advanced healthcare utilisation, which was not associated with the choice of reversal (adjusted OR (95%CI) 0.95 (0.89-1.01); p = 0.11). Equivalence testing supported an equivalent effect size of sugammadex and neostigmine on both outcomes, and neostigmine was non-inferior to sugammadex with regard to postoperative respiratory complications or advanced healthcare utilisation. Finally, there was no association between the reversal drug and major adverse cardiovascular events (adjusted OR 1.07 (0.94-1.21); p = 0.32). Compared with neostigmine, reversal of neuromuscular blockade with sugammadex was not associated with a reduction in postoperative respiratory complications or post-procedural advanced healthcare utilisation.
使用舒更葡糖钠逆转神经肌肉阻滞可消除残余麻痹，而残余麻痹与术后呼吸并发症相关。与新斯的明相比，关于舒更葡糖钠是否能减少这些并发症的数据并不明确。我们研究了逆转药物的选择与术后呼吸并发症和高级医疗资源利用之间的关联。我们纳入了2016年1月至2021年6月期间在两个学术医疗网络接受手术并接受舒更葡糖钠或新斯的明逆转全身麻醉的成年患者。主要结局是术后呼吸并发症，定义为拔管后氧饱和度<90%、需要无创通气的呼吸衰竭或7天内再次气管插管。我们的主要次要结局是高级医疗资源利用，这是一个综合结局，包括：7天内非计划入住重症监护病房；30天内再次入院；或非回家出院。在总共83250名纳入患者中，5746名（6.9%）出现了术后呼吸并发症。这与逆转药物无关（调整后的比值比（95%置信区间）为1.01（0.94 - 1.08）；p = 0.76）。排除来自专业护理机构的患者后，8372名（10.5%）患者需要高级医疗资源利用，这与逆转药物的选择无关（调整后的比值比（95%置信区间）为0.95（0.89 - 1.01）；p = 0.11）。等效性检验支持舒更葡糖钠和新斯的明在这两个结局上的效应大小相当，并且在术后呼吸并发症或高级医疗资源利用方面，新斯的明不劣于舒更葡糖钠。最后，逆转药物与主要不良心血管事件之间没有关联（调整后的比值比为1.07（0.94 - 1.21）；p = 0.32）。与新斯的明相比，使用舒更葡糖钠逆转神经肌肉阻滞与术后呼吸并发症或术后高级医疗资源利用的减少无关。
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