Sugammadex versus Neostigmine for Reversal of Rocuronium-Induced Neuromuscular Blockade: A Study of Thoracic Surgical Patients
BACKGROUND: Sugammadex is a novel agent for the reversal of neuromuscular paralysis. Neostigmine is more commonly used for reversal but is associated with side effects including bronchospasm, nausea/vomiting, hypotension, and bradycardia. While there has been anecdotal evidence that patients treated with sugammadex have better subjective measures of recovery compared to those treated with neostigmine, few studies have systematically evaluated this, especially in patients whose pre-existing pulmonary disease predisposes them to postoperative adverse respiratory events. The simultaneous evaluation of clinical outcomes, economic implications, and postoperative recovery quality could give evidence to support usage of a neuromuscular reversal agent with less side effects. HYPOTHESIS: In thoracic surgical patients, reversal with sugammadex as compared to neostigmine will result in less hypoxic episodes in the post-anesthesia care unit (PACU), improved postoperative recovery quality, and lower costs secondary to the faster reversal to extubation, reversal out of operating room (OR), and shorter PACU stay. METHODS: 100 adult patients undergoing thoracic surgery with general endotracheal anesthesia are enrolled into this double-blind study to evaluate three domains: physiological factors, nociceptive factors, and emotional factors. After obtaining baseline parameters, patients are randomized to one of two groups: one receiving 50mcg/kg, maximum 5mg of neostigmine mixed with 8mcg/kg, maximum of 1mg glycopyrrolate; the other receiving 2 mg/kg of sugammadex. Upon patient's PACU arrival, degree of neuromuscular function is assessed utilizing the TOF Watch accelerometer device, and parameters, including vitals, postoperative quality recovery scale (PQRS) assessment, adverse events, and drugs given, from the time the patient arrived in the PACU until discharge are observed and recorded. PRELIMINARY RESULTS: While approximately 81 patients have been enrolled so far, statistical analysis is pending more data collection; however, there appears to be two distinct groups, one of which has a significantly shorter reversal time as well as a shorter duration in the PACU than the other. It is predicted that those who receive sugammadex will experience better outcomes related to these factors. CONCLUSION: If there is a significant improvement as a result of sugammadex usage, a revision of current protocol for neuromuscular blockade reversal in thoracic surgical patients is recommended to improve patient outcomes and lower costs.