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ORIGINAL ARTICLE   

Minerva Anestesiologica 2021 January;87(1):13-25

DOI: 10.23736/S0375-9393.20.14589-9

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

Neuromuscular blockade management and postoperative outcomes in enhanced recovery colorectal surgery: secondary analysis of POWER trial

Ana B. SERRANO 1, 2 , Óscar DÍAZ-CAMBRONERO 3, Javier MELCHOR-RIPOLLÉS 4, Alfredo ABAD-GURUMETA 4, Jose M. RAMIREZ-RODRIGUEZ 5, Javier MARTÍNEZ-UBIETO 6, Miriam SÁNCHEZ-MERCHANTE 7, Rita RODRIGUEZ 8, Laura JORDÁ 9, Silvia GIL-TRUJILLO 10, Mercedes CABELLOS-OLIVARES 11, Daniel BORDONABA-BOSQUE 12, César ALDECOA 9, on behalf of POWER Group 

1Department of Anesthesiology, Ramón y Cajal University Hospital, Madrid, Spain; 2Instituto de Investigación Sanitaria Hospital Ramón y Cajal (IRYCIS), Madrid, Spain; 3Department of Anesthesiology, The University and Polytechnic La Fe Hospital of Valencia, Valencia, Spain; 4Department of Anesthesiology, Infanta Leonor University Hospital, Madrid, Spain; 5Department of General Surgery, Lozano Blesa University Hospital, Zaragoza, Spain; 6Department of Anesthesiology, Miguel Servet University Hospital, Zaragoza, Spain; 7Department of Anesthesiology, Fundación Alcorcón University Hospital, Madrid, Spain; 8Department of Anesthesiology, University Clinical Hospital of Valladolid, Valladolid, Spain; 9Department of Anesthesiology, University General Hospital of Castellón, Castellón, Spain; 10Department of Anesthesiology, Hospital General Universitario de Ciudad Real (HGUCR), Ciudad Real, Spain; 11Department of Anesthesiology, University Hospital of Guadalajara, Guadalajara, Spain; 12Institute for Health Sciences in Aragon (IACS), Centro de Investigación Biomédica de Aragón (CIBA), Zaragoza, Spain



BACKGROUND: We evaluated the impact of neuromuscular blockade (NMB) management, monitoring and reversal on postoperative outcomes in colorectal surgical patients included in an enhanced recovery program.
METHODS: We performed a predefined analysis in 2084 patients undergoing elective colorectal surgery who participated in POWER study. We analyzed them for complications, length of hospital stay and mortality. Two groups were defined: 1) monitoring + reversal of the neuromuscular blockade (M+R) group: all patients receiving neuromuscular blockade monitoring plus reversal of it with any drug (neostigmine or sugammadex) were included; and 2) no monitoring nor reversal (noM+noR) group. In this group all the patients who did not receive monitoring and reversal of the neuromuscular blockade were allocated.
RESULTS: Multivariate analysis found no statistically significant differences in moderate-severe complications (174 [25.7%] vs. 124 [27.1%]; P=0.607), length of hospital stay (10.8±11.1 vs. 11.0 ±12.6 days; P=0.683) and mortality (6 [0.9%] vs. 5 [1.1%]; P=0.840) between the group receiving optimal neuromuscular management (M+R) and the one did not receive it (noM+noR). Univariate analysis showed patients reversed with neostigmine died more than those reversed with sugammadex (3 [2.7%] vs. 3 [0.5%]; P=0.048).
CONCLUSIONS: Our data suggest optimal neuromuscular blockade management in colorectal surgery is not associated with less moderate-severe complications, length of hospital stay or death during postoperative period in an enhanced recovery program. Neostigmine reversal seems to be linked to higher rate of mortality than sugammadex.


KEY WORDS: Neuromuscular monitoring; Neuromuscular blockade; Neostigmine; Sugammadex; Postoperative complications

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