Comparison of neostigmine vs. sugammadex for recovery of muscle function after neuromuscular block by means of diaphragm ultrasonography in microlaryngeal surgery: A randomised controlled trial.
Eur J Anaesthesiol
; 37(1): 44-51, 2020 Jan.
Article
en En
| MEDLINE
| ID: mdl-31356374
ABSTRACT
BACKGROUND:
Postoperative residual curarisation (PORC) is a risk directly related to the use of neuromuscular blocking agents during surgical procedures. Acceleromyography is distressing for conscious patients when assessing PORC. Diaphragm ultrasonography could be a valid alternative.OBJECTIVES:
The primary objective was to achieve a 28% lower incidence of PORC in patients who, after rocuronium administration, received neostigmine or sugammadex at 30âmin after surgery. To assess PORC, diaphragm ultrasonography was used, and thickening fractioning [the difference of thickness at the end of inspiration (TEI) and at the end of expiration (TEE), normalised for TEE (TEIâ-âTEE/TEE)] was measured. PORC was defined as thickening fractioning of 0.36 or less. The secondary object was the comparison, in the two treatment groups, of the return to baseline thickening fractioning at 30âmin after surgery (ΔTF30).DESIGN:
Randomised, double-blind, single-centre study.SETTING:
University Hospital Careggi, Florence, Italy. PATIENTS Patients of American Society Anesthesiologists' physical status 1 or 2, 18 to 80 years, receiving rocuronium during microlaryngeal surgery.INTERVENTIONS:
At the end of surgery participants were randomised to receive neostigmine (NEO group) or sugammadex (SUG group) as the reversal drug. Thickening fractioning and ΔTF30 were evaluated at baseline and at 0, 10 and 30âmin after surgery. MAIN OUTCOMEMEASURES:
TEE and TEI at each time point.RESULTS:
A total of 59 patients with similar demographic characteristics were enrolled. An association between lack of recovery (thickening fractioning ≤0.36) and drug treatment was only observed at 0âmin (SUG vs. NEO, Pâ<â0.05). Concerning ΔTF, at 30âmin more patients in the SUG group returned to baseline than those in the NEO group (Pâ<â0.001), after adjusting for side (Pâ=â0.52), baseline thickening fractioning (Pâ<â0.0001) and time of measurement (Pâ<â0.01).CONCLUSION:
We found an early (0âmin) but not long-lasting (30âmin) association between diaphragm failure and treatment allocation; a full recovery in baseline diaphragm function was observed only in patients receiving sugammadex. We cannot exclude that further differences have not been found due to interpatients variability in assessing diaphragm contractility by ultrasonography. TRIAL REGISTRATION EudraCT Identifier 2013-004787-62, Clinicaltrials.gov Identifier NCT02698969.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Bloqueo Neuromuscular
/
Retraso en el Despertar Posanestésico
/
Sugammadex
/
Rocuronio
/
Neostigmina
Tipo de estudio:
Clinical_trials
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Diagnostic_studies
/
Etiology_studies
/
Prognostic_studies
Límite:
Adult
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Aged
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Female
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Humans
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Male
/
Middle aged
Idioma:
En
Revista:
Eur J Anaesthesiol
Asunto de la revista:
ANESTESIOLOGIA
Año:
2020
Tipo del documento:
Article