|
1
|
Ajetunmobi O, Wong D, Perlas A, Rajaleelan W, Wang S, Huszti E, Jackson T, Chung F, Wong J. Impact of Sugammadex Versus Neostigmine Reversal on Postoperative Recovery Time in Patients With Obstructive Sleep Apnea Undergoing Bariatric Surgery: A Double-Blind, Randomized Controlled Trial. Anesth Analg 2024:00000539-990000000-00835. [PMID: 38848257 DOI: 10.1213/ane.0000000000007013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
BACKGROUND 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. METHODS 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. RESULTS We randomized 120 patients into 2 groups of 60 patients. Overall median body mass index (BMI) was 48.1 kg/m2 ([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. CONCLUSIONS No difference was observed in OR discharge time in morbidly obese patients with OSA when sugammadex was administered instead of neostigmine.
Collapse
Affiliation(s)
- Olawale Ajetunmobi
- From the Department of Anesthesiology, Surrey Memorial Hospital, Surrey, British Columbia, Canada
| | - David Wong
- Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Anahi Perlas
- Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Wesley Rajaleelan
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Stella Wang
- Department of Biostatistics, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ella Huszti
- Department of Biostatistics, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Timothy Jackson
- Department of Surgery, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Frances Chung
- Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jean Wong
- Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
|
2
|
Subramani Y, Riad W, Chung F, Wong J. Optimal propofol induction dose in morbidly obese patients: A randomized controlled trial comparing the bispectral index and lean body weight scalar. Can J Anaesth 2017; 64:471-479. [DOI: 10.1007/s12630-017-0852-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/26/2016] [Accepted: 02/21/2017] [Indexed: 12/28/2022] Open
|