TOPLINE:
No significant differences in discharge times from the operating room were observed between patients with severe obesity and obstructive sleep apnea who received sugammadex or neostigmine while undergoing bariatric surgery.
METHODOLOGY: This prospective, double-blinded randomized controlled trial conducted at Toronto Western Hospital in Toronto, Ontario, Canada, included 120 adults diagnosed with obstructive sleep apnea who underwent elective bariatric surgery with general anesthesia. Participants were randomly assigned to receive either sugammadex (2 mg/kg) or neostigmine (2.5 mg/kg) and glycopyrrolate (0.4 mg/kg) at the end of surgery. The researchers measured the time from drug administration to extubation, moving on their own from the operating room table to a bed, discharge to the post anesthesia care unit. Duration of anesthesia, length of stay in the postanesthesia care unit, and duration of hospital stay were also measured. Cases of upper airway obstruction, hypoxemia, and need for interventions after extubation were also recorded. TAKEAWAY: No significant difference was observed in operating room discharge times between the sugammadex (13 minutes) and neostigmine (13.5 minutes) groups (P=.27). The durations from drug administration to extubation (P=.30), eye opening (P=.77), and patient movement from the operating room table to bed (P=.46) did not significantly differ between the groups. The number of postoperative complications were also similar between the sugammadex and neostigmine groups. Study authors acknowledged other research that found sugammadex was superior in reducing adverse postoperative respiratory events than neostigmine, but said they only sought to analyze the immediate, in-hospital outcomes. IN PRACTICE:
The authors wrote, “In morbidly obese patients with OSA [obstructive sleep apnea], the use of sugammadex for reversal did not result in a reduction in the operating room discharge time.”
SOURCE:
The study was led by Olawale Ajetunmobi, MB, DA, from Toronto Western Hospital, University Health Network at the University of Toronto in Toronto, Ontario, Canada. It was published online on June 7, 2024, in Anesthesia & Analgesia.
LIMITATIONS:
The study was not powered to detect differences in postoperative complication rates. The design of the study predated recent guidelines recommending quantitative neuromuscular blocking measurements for neostigmine reversal.
DISCLOSURES:
This study was partly supported by a research grant from Merck Sharp & Dohme. Some authors declared serving as consultants, being on advisory boards, or receiving research support from various sources.
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