Antagonization of neuromuscular blockade by sugammadex vs. neostigmine in patients undergoing robotic‑assisted urological procedures – effect on extubation time and quality of the recovery – monocentric prospective randomized study

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Authors: J. Schraml ¹; V. Kokoška ¹; M. Broul ^1,2; R. Škulec ^3,4; J. Škola ³; D. Astapenko ⁵; V.- Černý ^{3,5,6 8}
Authors place of work: Klinika urologie a robotické chirurgie, Univerzita J. E. Purkyně v Ústí nad Labem, Masarykova nemocnice v Ústí nad Labem ¹; Sexuologické oddělení, Masarykova nemocnice v Ústí nad Labem ²; Klinika anesteziologie, perioperační a intenzivní medicíny, Univerzita J. E. Purkyně v Ústí nad Labem, Masarykova nemocnice v Ústí nad Labem ³; Zdravotnická záchranná služba Středočeského kraje ⁴; Klinika anesteziologie, resuscitace a intenzivní medicíny, Fakultní nemocnice Hradec Králové a Lékařská fakulta, v Hradci Králové, Univerzita Karlova ⁵; Centrum pro výzkum a vývoj, Fakultní nemocnice Hradec Králové ⁶; Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Kanada ⁷; Technická univerzita v Liberci ⁸
Published in the journal: Anest. intenziv. Med., 32, 2021, č. 4-5, s. 191-196
Category: Original Papers

Summary

Objective: The aim of the study was to test the hypothesis that the use of sugammadex shortens the time to extubation
compared to the use of neostigmine in patients undergoing robotically assisted urological procedures.
Design: Monocentric prospective randomized study.
Setting: Tertiary Care Hospital.
Material and methods: Sixty adult patients undergoing robotic-assisted urological laparoscopic surgery without contraindications
to the administration of rocuronium, neostigmine and sugammadex, with perioperative monitoring of the depth
of neuromuscular blockade. Patients were randomized to the group with antagonization of the neuromuscular blockade
with either neostigmine or sugammadex. Primary outcome was time to extubation from injection of the antagonist.
Results: Sixty-one patients with ASA I–III were enrolled. The time to extubation was significantly shorter in the sugammadex
group compared to neostigmine group: 10; 3.5–35 minutes, 45; 16–88 minutes respectively, p < 0.00001 (data shown as
an average; minimum – maximum range). In addition, patients in the sugammadex group were transported significantly
faster from the operating room. There were no differences in the quality and rate of recovery in 72 hours postoperatively.
Conclusion: Sugammadex statistically significantly accelerated the time from administration to extubation in ASA I–III
patients after robotic-assisted urologic laparoscopic surgery compared to neostigmine. Thus, sugammadex significantly
accelerated the patients’ operating room turn-over time.

Keywords:

robotic surgery – Neuromuscular blockade – sugammadex – neostigmine – extubation

Zdroje

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