Ajetunmobi Olawale, Wong David, Perlas Anahi, Rajaleelan Wesley, Wang Stella, Huszti Ella, Jackson Timothy, Chung Frances, Wong Jean
From the Department of Anesthesiology, Surrey Memorial Hospital, Surrey, British Columbia, Canada.
Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Anesth Analg. 2025 Mar 1;140(3):568-576. doi: 10.1213/ANE.0000000000007013. Epub 2024 Jun 7.
Residual neuromuscular blockade can be associated with serious postoperative complications. Sugammadex is a newer neuromuscular blocking drug (NMBD) reversal agent that rapidly and completely reverses rocuronium. Whether sugammadex has any advantages over neostigmine in morbidly obese patients with obstructive sleep apnea (OSA) is unclear. We investigated whether sugammadex would reduce discharge time from the operating room (OR) compared with neostigmine in morbidly obese patients with OSA undergoing bariatric surgery.
This was a prospective, double-blinded randomized controlled superiority trial with 2 parallel groups. Patients were randomized 1:1 into reversal of NMBD with sugammadex or neostigmine. Our inclusion criteria were morbidly obese adult patients with OSA undergoing elective bariatric surgery under general anesthesia. Our exclusion criteria were allergy to rocuronium, sugammadex or neostigmine, malignant hyperthermia, hepatic or renal insufficiency, neuromuscular diseases, and an inability to give consent. The primary outcome was the time from administration of the NMBD reversal agent to discharge from the OR. Secondary outcomes included the time from administration of the NMBD reversal agent to the time the patient opened eyes to command, and the time to extubation. The Mann-Whitney test was used to compare the outcomes between treatment groups.
We randomized 120 patients into 2 groups of 60 patients. Overall median body mass index (BMI) was 48.1 kg/m 2 ([interquartile range, IQR]) [43.0-53.5]. The time from drug administration to discharge from OR was 13.0 minutes [10.0-17.0] in the sugammadex group and 13.5 minutes [11.0-18.3] in the neostigmine group ( P = .27). The treatment effect estimate with a bootstrapped 95% confidence interval [CI] for time from admission to discharge from OR was -0.5 [-2.5 to 3]. No differences were observed in postoperative complications and other secondary outcomes.
No difference was observed in OR discharge time in morbidly obese patients with OSA when sugammadex was administered instead of neostigmine.
残余神经肌肉阻滞可能与严重的术后并发症相关。舒更葡糖钠是一种新型的神经肌肉阻滞药物（NMBD）逆转剂，可快速、完全地逆转罗库溴铵的作用。在患有阻塞性睡眠呼吸暂停（OSA）的病态肥胖患者中，舒更葡糖钠与新斯的明相比是否具有任何优势尚不清楚。我们研究了在接受减肥手术的患有OSA的病态肥胖患者中，与新斯的明相比，舒更葡糖钠是否会减少手术室（OR）出院时间。
这是一项前瞻性、双盲随机对照优势试验，有2个平行组。患者按1:1随机分为用舒更葡糖钠或新斯的明逆转NMBD组。我们的纳入标准是在全身麻醉下接受择期减肥手术的患有OSA的病态肥胖成年患者。我们的排除标准是对罗库溴铵、舒更葡糖钠或新斯的明过敏、恶性高热、肝或肾功能不全、神经肌肉疾病以及无法给予同意。主要结局是从给予NMBD逆转剂到从OR出院的时间。次要结局包括从给予NMBD逆转剂到患者对指令睁眼的时间以及拔管时间。采用Mann-Whitney检验比较治疗组之间的结局。
我们将120例患者随机分为2组，每组60例。总体中位体重指数（BMI）为48.1 kg/m²（[四分位间距，IQR]）[43.0 - 53.5]。舒更葡糖钠组从给药到从OR出院的时间为13.0分钟[10.0 - 17.
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