Role of sugammadex in accelerating postoperative discharge: A meta-analysis.

STUDY OBJECTIVE: Sugammadex has been introduced for reversal of neuromuscular blockade (NMB) induced by rocuronium (or vecuronium). Although its efficacy and safety have been established, data are conflicting as to whether it accelerates discharge to the surgical ward compared with neostigmine, which is traditionally used for reversing NMB. The object of this systematic review and meta-analysis was to review the research comparing sugammadex and neostigmine in the context of patient discharge after general anesthesia. DESIGN: Systematic review and meta-analysis. SETTING: University medical hospital. PATIENTS: Five-hundred eighteen patients from six studies were included. METHODS: A comprehensive search was conducted using PubMed, Web of Science, Google Scholar, and Cochrane Library electronic databases to identify randomized controlled trials written in English. Two reviewers independently selected the studies, extracted data regarding postoperative discharge, and assessed the trials' methodological quality and evidence level. Postoperative discharge time was determined from the operating room (OR) to the postanesthesia care unit (PACU) and from the PACU to the surgical ward. This study was conducted using PRISMA methodology. MEASUREMENTS: Time to discharge after NMB reversal with sugammadex or neostigmine. MAIN RESULTS: Compared with neostigmine, sugammadex was associated with a significantly faster discharge from the OR to the PACU (mean difference [MD]=22.14min, 95% CI (14.62, 29.67), P<0.0001, I2=0%) and from the PACU to the surgical ward (MD=16.95min, 95% CI (0.23, 33.67), P=0.0469, I2=98.4%). Similarly, discharge-readiness was shorter for sugammadex than for neostigmine from the OR to the PACU (MD=5.58min, 95% CI (3.03, 8.14), P≤0.0001, I2=0%). However, discharge-readiness was similar in both groups for patients moving from the PACU to the surgical ward (MD=-1.10min, 95% CI (-5.69, 3.50), P=0.6394, I2=25.3%). CONCLUSIONS: Results from this meta-analysis suggest that sugammadex accelerates postoperative discharge of patients after general anesthesia compared with neostigmine.

Pump flow changes do not impair sublingual microcirculation during cardiopulmonary bypass.

OBJECTIVE: The flow rate of the cardiopulmonary bypass (CPB) pump used in cardiac surgery often undergoes inherent fluctuations ranging from 10% to 20% of its theoretic value. However, the effects of such alterations remain unknown. In the present study, the authors investigated whether such variations could induce changes in the microvascular flow, which is considered a primary indicator of poor perfusion. DESIGN: A prospective, observational, clinical study. SETTING: A university-affiliated teaching hospital. PARTICIPANTS: Thirty adult patients undergoing elective cardiac surgery with CPB. INTERVENTIONS: Analysis of the sublingual microcirculation during CPB using a pump flow rate of 80% or 100% of the theoretic value. MEASUREMENTS AND MAIN RESULTS: Sidestream dark field (SDF) imaging was used to record 2 video clips of the sublingual microcirculation in each patient. The videos were recorded at the same site at 80% and 100% of the theoretic flow rate. Microvascular analysis displaying the De Backer score, the microvascular flow index, the total vessel density, the perfused vessel density, and the proportion of perfused vessels was performed. Moreover, the mean arterial pressure (MAP), SvO(2), and PaCO(2) were evaluated. No significant changes in the measured parameters were noted at the 2 different flow rates. CONCLUSIONS: Changes in the CPB pump flow rate within 20% (80%-100%) of its theoretic value do not alter the sublingual microcirculation. Thereafter, it is conceivable that during perioperative adjustments of the CPB pump rate, blood flow autoregulation mechanisms are activated so that limited changes in the pump flow can be considered safe not only at the sublingual site but also for the entire microcirculation.