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Minerva Anestesiologica 2018 February;84(2):178-88

DOI: 10.23736/S0375-9393.17.11856-0


language: English

Effect of sugammadex on coagulation as detected by rotational thromboelastometry in morbidly obese patients

Michele CARRON 1 , Diana BERTINI 1, Tancredi PRANDINI 1, Francesca FANTON 1, Mirto FOLETTO 2, Carlo ORI 1, Egle PERISSINOTTO 3, Paolo SIMIONI 4

1 Section of Anesthesiology and Intensive Care, Department of Medicine - DIMED, University of Padua, Padua, Italy; 2 Section of Surgery, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy; 3 Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy; 4 Unit of Thrombotic and Hemorrhagic Diseases, Department of Medicine - DIMED, University of Padua, Padua, Italy


BACKGROUND: Sugammadex, which is used to reverse rocuronium-induced neuromuscular blockade, has a limited and transient effect on activated partial thromboplastin time and prothrombin time. However, no data are available on the effects of sugammadex on coagulation in morbidly obese patients, as assessed by rotational thromboelastometry (ROTEM®).
METHODS: Sixty patients received sugammadex 2 mg/kg or 4 mg/kg to reverse moderate or deep rocuronium-induced neuromuscular blockade (N.=30/group) at the end of surgery under desflurane anesthesia. Arterial blood samples were collected before and 3 min and 30 min after sugammadex administration for ROTEM® analysis, including measurements of clotting time (CT), clot formation time, α angle, and maximum clot firmness in INTEM, EXTEM, and FIBTEM assays. Major and minor bleeding events were also monitored during the postoperative period.
RESULTS: Sugammadex 2 and 4 mg/kg has a limited and transient (<30 min) effect on INTEM CTs of 7.7% (P=0.04) and 10.7% (P<0.0001), respectively. There were no relevant effects on other ROTEM® parameters. A multivariate analysis indicated a significant effect of total sugammadex dose (<250, 250-500, >500 mg) on the INTEM CT (P=0.002). A regression analysis showed a positive relationship between sugammadex dose and INTEM CT value at 3 min after administration (coefficient = 0.052 s; 95% CI: 0.005-0.098 s; P=0.03). No major or minor bleeding events were observed in either group during the postoperative period.
CONCLUSIONS: Sugammadex produces a slight effect on coagulation in morbidly obese patients, without increasing the risk for postoperative bleeding.

KEY WORDS: Obesity, morbid - Blood coagulation - Hemorrhage - Neuromuscular blockade - Thrombelastography

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