Anaesthesia for irreversible electroporation (IRE) prostatectomy: Reversal of neuromuscular blockade with sugammadex vs neostigmin. Retrospective study

Česká verzia

Authors: Herold Ivan ¹; Sittová Naděžda ¹; Čurdová Marcela ¹; Kolombo Ivan ²; Pabišta Richard ³; Adamus Milan ⁴
Authors place of work: Anesteziologicko-resuscitační oddělení, Oblastní nemocnice Mladá Boleslav, a. s. ¹; Centrum robotické chirurgie a urologie, Nemocnice Na Homolce, Praha ²; Urologické oddělení, Oblastní nemocnice Mladá Boleslav, a. s. ³; Klinika anesteziologie, resuscitace a intenzivní medicíny, FN a LF UP v Olomouci ⁴
Published in the journal: Anest. intenziv. Med., 24, 2013, č. 4, s. 230-236
Category: Anaesthesiology - Original Paper

Summary

Objective:
Assessment of factors influencing the reversal of neuromuscular blockade with sugammadex (S) and neostigmin (N) in IRE prostatectomy requiring deep neuromuscular block until the end of surgery.

Type:
Retrospective study, analysis of anaesthesia charts.

Setting:
Department of Urology, Department of Anaesthe-siology and Intensive Therapy.

Materials and methods:
During a 5-month period (November 2011–March 2012) IRE prostatectomy were performed in 35 men in balanced general anaesthesia with rocuronium. At the end of surgery, S 200 mg (BRIDION) or N (NEOSTIGMIN) were administered for the reversal of deep block (TOF-count 0, PTC ≥ 5) or moderate block (TOF-count ≥ 1) respectively. We analysed the relation of the reversal to the rocuronium admini-stration: the intubation dose, total dose (absolute, per kg of body weight, number of supplementing boluses), duration of anaesthesia and ASA using non-parametric Mann Whitney and Fischer exact tests. Results are presented as mean values.

Results:
Sugammadex 200 mg (2.21 mg/kg) was administered in 22 (63%) patients with deep block (BRIDION group), neostigmin (0.027 mg/kg) in 13 (37%) patients with moderate block (NEOSTIGMIN group). Comparing to NEOSTIGMIN, higher doses of rocuronium – absolute dose (82.5 vs 65 mg, p = 0.001) and dose/kg bw (0.85 vs 0.69 mg/kg, p = 0.018) were given, the number of rocuronium boluses was higher (p = 0.013) and the anaesthesia was longer (100 vs 90 min, p = 0.044) in the BRIDION group. A dose of S 200 mg was sufficient in 20 patients (91 %) for block reversal. In 2 patients with a lower sugammadex dose (< 1.6 mg/kg), a supplement dose of 100 mg was required for complete block recovery after 3.5 min.

Conclusion:
In IRE prostatectomy, rocuronium-sugammadex combination appears to be a cost-effective strategy. A standard dose of 200 mg sugammadex at the end of surgery might be insufficient in obese patients (in doses < 1.6 mg/kg).

Keywords:
neuromuscular blockade – akcelerometry – reversal –neostigmin–sugammadex–prostatectomy–irreversible electroporation

Zdroje

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Článok vyšiel v časopise

Anaesthesiology and Intensive Care Medicine

2013 Číslo 4

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