Paredes Stephania, Ott Sascha, Rössler Julian, Cekmecelioglu Busra T, Trombetta Carlos, Li Yufei, Turan Alparslan, Ruetzler Kurt, Chhabada Surendrasingh
Division of Multi-Specialty Anesthesiology, Department of Anesthesiology & Pain Management, Cleveland Clinic, Cleveland, OH, USA.
Outcomes Research Consortium, Houston, TX, USA.
Can J Anaesth. 2025 Apr;72(4):591-602. doi: 10.1007/s12630-024-02904-0. Epub 2025 Jan 30.
Residual neuromuscular blockade can impair postoperative respiratory mechanics, promoting hypoxemia and pulmonary complications. Sugammadex, with its unique mechanism of action, may offer a more effective reversal of neuromuscular blockade and respiratory function than neostigmine. We sought to test the primary hypothesis that children undergoing noncardiac surgery exhibit better initial recovery oxygenation when administered sugammadex than those administered neostigmine. Furthermore, we aimed to investigate if children administered sugammadex experience fewer in-hospital pulmonary complications.
In a retrospective cohort study, we analyzed data from children aged 2-17 yr who underwent noncardiac surgery with general anesthesia and received neostigmine or sugammadex between January 2017 and April 2023 at the Cleveland Clinic Main Campus. Our primary outcome was postoperative oxygenation defined by the mean SpO/FO ratio during the initial hour in the postanesthesia care unit. The secondary outcome was a composite of postoperative pulmonary complications during the hospital stay.
Among 3,523 cases, 430 (12.5%) involved sugammadex and 3,081 (87.5%) involved neostigmine. The median [interquartile range] of the mean SpO/FO ratio during the first postoperative hour was 403 [356-464] in the sugammadex group and 408 [357-462] in the neostigmine group, resulting in an estimated difference in means of -6.2 (95% confidence interval, -12.8 to 0.41; P = 0.07) after inverse probability of treatment weighting. Overall, 22/1,916 (1.1%) inpatients experienced postoperative pulmonary complications; 2.0% of patients given sugammadex and 1.0% of patients administered neostigmine developed postoperative pulmonary complications (P = 0.19).
In this retrospective cohort study, postoperative oxygenation was similar in children after reversal of neuromuscular blockade with sugammadex versus neostigmine.
残余神经肌肉阻滞可损害术后呼吸力学，导致低氧血症和肺部并发症。舒更葡糖钠具有独特的作用机制，与新斯的明相比，可能能更有效地逆转神经肌肉阻滞和改善呼吸功能。我们试图验证主要假设，即接受非心脏手术的儿童使用舒更葡糖钠后，其初始恢复氧合情况优于使用新斯的明的儿童。此外，我们旨在调查使用舒更葡糖钠的儿童是否发生较少的院内肺部并发症。
在一项回顾性队列研究中，我们分析了2017年1月至2023年4月在克利夫兰诊所主院区接受全身麻醉下非心脏手术并接受新斯的明或舒更葡糖钠治疗的2至17岁儿童的数据。我们的主要结局是术后氧合，定义为麻醉后护理单元初始1小时内的平均SpO/FO比值。次要结局是住院期间术后肺部并发症的综合情况。
在3523例病例中，430例（12.5%）使用了舒更葡糖钠，3081例（87.5%）使用了新斯的明。舒更葡糖钠组术后第1小时平均SpO/FO比值的中位数[四分位数间距]为403[356 - 464]，新斯的明组为408[357 - 462]，经治疗权重逆概率分析后，估计均值差异为-6.2（95%置信区间，-12.8至0.41；P = 0.07）。总体而言，1916例住院患者中有22例（1.1%）发生术后肺部并发症；使用舒更葡糖钠的患者中有2.0%发生术后肺部并发症，使用新斯的明的患者中有1.0%发生术后肺部并发症（P = 0.19）。
在这项回顾性队列研究中，使用舒更葡糖钠与新斯的明逆转神经肌肉阻滞后，儿童术后氧合情况相似。
