Comparison of sugammadex vs. neostigmine use in recovery of muscle relaxation related to vecuronium in obesity surgery

Authors

Keywords:

Obesity, Deep neuromuscular blockade, Sugammadex, Neostigmine, Bariatric Surgery

Abstract

Aim: There are many methods in anesthesia to measure the recovery after the use of neuromuscular blocking agent. Monitoring the neuromuscular function can be used to identify the residual blocks. The importance of morbid obesity in anesthesia is caused by the difficulty in succeeding sufficiency of respiration and patency of airway. There are so many methods to measure the recovery when the neuromuscular blocking agent is used. Monitoring the neuromuscular function is used to identify the residual blocks.

Methods: We designed a retrospective study with cross-sectional design. After power analysis 40 morbid obese patients operated with laparoscopic sleeve gastrectomy to treat the obesity, have been included in the study. 40 patients with sugammadex group S and neostigmine group were divided into two groups as equal.

Results: In group S, there were 14 female and 6 male having the average of 33.25 ages and the average of body mass index (BMI) as 42.96. In group N, there were 16 women and 4 men having the average of 37.55 ages and the average of BMI as 42.96. While in group S the basal Train of four (TOF) value was 89.75%, in group N basal TOF was 90.65%. The duration of extubation in group S was measured 1 min and 40 sec but in group N it was measured 4 min and 39 sec. Also, the duration of recovery of muscle strength as an indicator of the recovery of basal TOF values was observed as 3 min and 15 sec in group S, and it was observed as 6 min and 18 sec in group N (P<0.001). The duration of extubation in group N was longer than in group S (P<0.001). Also, the duration of the recovery of basal TOF values as the duration of recovery of muscle strength was longer in group N than in group S (P<0.001). 

Conclusions: While in the study with rocuronium, the duration of recovery of muscle strength with sugammadex got shorter 4 times, in our study this duration was become shorter 2 times. It can be explained as the long effects of vecuronium.

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References

Van Lancker P, Dillemans B, Bogaert T, Mulier JP, De Kock M, Haspeslagh M. Ideal versus corrected body weight for dosage of sugammadex in morbidly obese patients. Anaesthesia. 2011 Aug;66(8):721-5.

Arıkan N, Alper I, Ulukaya S, Balcıoğlu ST, Yegül İ. Morbid Obez Hastalarda Rokuronyumun Farmakodinamik Etkileri. Türk Anest Der Dergisi 2009;37(4):234-9.

vanRutte PWJ, Luyer P, deHingh IHJT, Nienhuijs SW. To Sleeve or NOT to Sleeve in Bariatric Surgery? ISRN Surgery 2012;674042.

Putz L, Dransart C, Jamart J, Marotta ML, Delnooz G, Dubois PE. Operating room discharge after deep neuromuscular block reversed with sugammadex compared with shallow block reversed with neostigmine: a randomized controlled trial. J Clin Anesth. 2016 Dec;35:107-13. doi: 10.1016/j.jclinane.2016.07.030.

T. Suzuki, G. Masaki, S. Ogawa. Neostigmine-induced reversal of vecuronium in normal weight, overweight and obese female patients. British Journal of Anaesthesia. 2006;97(2):160–3.

G. Geldner M, Niskanen P, Laurila V, Mizikov M, Hu¨bler G, Beck H, et al. A randomised controlled trial comparing sugammadex and neostigmine at different depths of neuromuscular blockade in patients undergoing laparoscopic surgery. Anaesthesia. 2012;67:991–8.

Suy K, Morias K, Cammu G, Hans P, van Duijnhoven WG, Heeringa M, et al. Effective reversal of moderate rocuronium- or vecuronium-induced neuromuscular block with sugammadex, a selective relaxant binding agent. Anesthesiology. 2007 Feb;106(2):283-8.

Gijsenbergh F, Ramael S, Houwing N, van Iersel T. First human exposure of Org 25969, a novel agent to reverse the action of rocuronium bromide. Anesthesiology.2005;103:695–703.

Carron M, Zarantonello F, Lazzarotto N, Tellaroli P, Ori C. Role of sugammadex in accelerating postoperative discharge: A meta-analysis. Journal of Clinical Anesthesia. 2017;39:38–44. doi:10.1016/j.jclinane.2017.03.004.

Naguib M. Sugammadex: another milestone in clinical neuromuscular pharmacology. Anesth Analg. 2007;104:575–81.

Mirakhur RK. Sugammadex in clinical practice. Anaesthesia. 2009;64(Suppl. 1):45–54.

Adams JP, Murphy PG. Obesity in anesthesia and intensive care. British Journal of Anesthesia. 2000;85:91-108.

Badaoui R, Cabaret A, Alami, Y, Zogheib E, Popov I, Lorne E, et al. Reversal of neuromuscular blockade by sugammadex in laparoscopic bariatric surgery: In support of dose reduction. Anaesth Crit Care Pain Med. 2016 Feb;35(1):25-9. doi: 10.1016/j.accpm.2015.09.003.

Weinstein JA, Matteo RS, Ornstein E, Schwartz AE, Goldstoff M, Thal G. Pharmacodynamics of vecuronium and atracurium in the obese surgical patient. Anesth Analg. 1988 Dec;67(12):1149-53.

Gaszynski T, Szewczyk T, Gaszynski W. Randomized comparison of sugammadex and neostigmine for reversal of rocuronium-induced muscle relaxation in morbidly obese undergoing general anaesthesia. Br J Anaesth. 2012 Feb;108(2):236-9. doi: 0.1093/bja/aer330. Epub 2011 Oct 19.

O'Reilly-Shah VN, Lynde GC, Mitchell ML, Maffeo CL, Jabaley CS, Wolf FA. Initial experience with the unrestricted introduction of sugammadex at a large academic medical center: a retrospective observational study examining postoperative mechanical ventilation and efficiency outcomes. Korean J Anesthesiol. 2018 Oct;71(5):374-85. doi: 10.4097/kja.d.18.00063.

Evron S, Abelansky Y, Ezri T, Izakson A. Respiratory events with sugammadex vs. neostigmine following laparoscopic sleeve gastrectomy: a prospective pilot study assessing neuromuscular reversal strategies. Rom J Anaesth Intensive Care. 2017 Oct;24(2):111-4. doi: 10.21454/rjaic.7518.242.evr.

Piskin O, Altinsoy B, Cimencan M, Aydin BG, Okyay D, Kucukosman G, et al. The effect of bariatric anaesthesia on postoperative pulmonary functions. J Pak Med Assoc. 2017 Apr;67(4):561-7.

Erkoç SK, Yılmaz AA. Bariatrik anestezi, postoperatif bakım ve komplikasyonlar. Anestezi Dergisi 2016;24:139-53.

Paech MJ, Kaye R, Baber C, Nathan EA. Recovery characteristics of patients receiving either sugammadex or neostigmine and glycopyrrolate for reversal of neuromuscular block: a randomised controlled trial. Anaesthesia. 2018;73(3):340-7.

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Published

2019-04-28

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Section

Research Article

How to Cite

1.
Mete A, Karaduman S, Sungurtekin H, Kılıç O. Comparison of sugammadex vs. neostigmine use in recovery of muscle relaxation related to vecuronium in obesity surgery. J Surg Med [Internet]. 2019 Apr. 28 [cited 2022 Aug. 19];3(4):307-10. Available from: https://jsurgmed.com/article/view/553419