ORIGINAL ARTICLE   Free

Minerva Anestesiologica 2017 March;83(3):248-54

DOI: 10.23736/S0375-9393.16.11489-0

Copyright © 2016 EDIZIONI MINERVA MEDICA

lingua: Inglese

The effect of routine availability of sugammadex on postoperative respiratory complications: a historical cohort study

Benjamin L. OLESNICKY, Catherine TRAILL, Frank B., MARROQUIN‑HARRIS ✉

Northern Sydney Anesthetic Research Institute, Department of Anesthesia, Royal North Shore Hospital, Sydney, Australia

BACKGROUND: Postoperative residual curarization is a preventable cause of postoperative morbidity. Although sugammadex has been shown to reduce the risk of residual curarization, it has not yet been shown if this directly translates to a reduction in morbidity. We aimed to demonstrate whether the introduction of unrestricted sugammadex for routine reversal changed the incidence of postoperative respiratory diagnoses and the rate of airway and respiratory complications in the postoperative care unit.
METHODS: A historical cohort study of 1257 patients who underwent general surgical or ear, nose and throat procedures before and after the introduction of unrestricted availability of sugammadex. Patient records were used to identify the incidence of postoperative in-hospital respiratory diagnoses and of airway complications in post-anesthesia care unit, the pattern of muscle relaxant use and the relative costs associated with the routine availability of sugammadex.
RESULTS: Unrestricted sugammadex availability was associated with a significant reduction in the rate of a postoperative in-hospital respiratory diagnosis (odds ratio [OR] 0.20; 95% CI: 0.05-0.72, P=0.01). Furthermore, the use of sugammadex itself was also associated with a reduction in in-hospital respiratory diagnoses (OR=0.26; 95% CI: 0.08-0.94, P=0.04). Unrestricted sugammadex was also associated with a decrease in the need for manual airway support in the recovery room (3.2% vs. 1.1%, P=0.02) and a decrease in patients being transferred intubated to ICU (5.5% vs. 1.3%, P<0.001).
CONCLUSIONS: Unrestricted sugammadex availability is associated with a reduction in postoperative respiratory complications. A well-designed, prospective randomized trial is needed to provide further validation of the data.

KEY WORDS: Cohort studies - Delayed emergence from anesthesia - Humans - Postoperative care - Gamma-cyclodextrins