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Reversal of residual neuromuscular block with neostigmine or sugammadex and postoperative pulmonary complications: A prospective, randomised, double-blind trial in high-risk older patients

Residual neuromuscular block is associated with an increased risk of postoperative pulmonary complications in retrospective studies. The aim of our study was to investigate prospectively the incidence of postoperative pulmonary complications after reversal with either sugammadex (SUG) or neostigmine...

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Main Authors: Ledowski, Thomas, Szabo-Maak, Zoltan, San Loh, Pui, Turlach, Berwin A., Yang, Hong Seuk, de Boer, Hans D., Asztalos, Laszlo, Shariffuddin, Ina Ismiarti, Chan, Lucy, Fulesdi, Bela
Format: Article
Published: Elsevier Sci Ltd 2021
Subjects:
R Medicine
RA Public aspects of medicine
Online Access:http://eprints.um.edu.my/34363/
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spelling my.um.eprints.343632022-09-12T07:56:56Z http://eprints.um.edu.my/34363/ Reversal of residual neuromuscular block with neostigmine or sugammadex and postoperative pulmonary complications: A prospective, randomised, double-blind trial in high-risk older patients Ledowski, Thomas Szabo-Maak, Zoltan San Loh, Pui Turlach, Berwin A. Yang, Hong Seuk de Boer, Hans D. Asztalos, Laszlo Shariffuddin, Ina Ismiarti Chan, Lucy Fulesdi, Bela R Medicine RA Public aspects of medicine Residual neuromuscular block is associated with an increased risk of postoperative pulmonary complications in retrospective studies. The aim of our study was to investigate prospectively the incidence of postoperative pulmonary complications after reversal with either sugammadex (SUG) or neostigmine (NEO) in high-risk older patients. Methods: We randomly allocated 180 older patients with significant morbidity (ASA physical status 3) >= 75 yr old to reversal of rocuronium with either SUG or NEO. Adverse events in the recovery room and pulmonary complications (defined by a 5-point 0-4; 0= best to 4= worst] outcome score) on postoperative Days 1, 3, and 7 were compared between groups. Results: Data from 168 patients aged 80 (4) yr were analysed; SUG vs NEO resulted in a reduced probability (0.052 vs 0.122) of increased pulmonary outcome score (impaired outcome) on postoperative Day 7, but not on Days 1 and 3. More patients in the NEO group were diagnosed with radiographically confirmed pneumonia (9.6% vs 2.4%; P=0.046). The NEO group showed a non-significant trend towards longer hospital length of stay across all individual centres (combined 9 vs 7.5 days), with a significant difference in Malaysia (6 vs 4 days; P=0.011). Conclusions: Reversal of rocuronium neuromuscular block with SUG resulted in a small, but possibly clinically relevant improvement in pulmonary outcome in a select cohort of high-risk older patients. Elsevier Sci Ltd 2021-08 Article PeerReviewed Ledowski, Thomas and Szabo-Maak, Zoltan and San Loh, Pui and Turlach, Berwin A. and Yang, Hong Seuk and de Boer, Hans D. and Asztalos, Laszlo and Shariffuddin, Ina Ismiarti and Chan, Lucy and Fulesdi, Bela (2021) Reversal of residual neuromuscular block with neostigmine or sugammadex and postoperative pulmonary complications: A prospective, randomised, double-blind trial in high-risk older patients. British Journal of Anaesthesia, 127 (2). pp. 316-323. ISSN 0007-0912, DOI https://doi.org/10.1016/j.bja.2021.04.026 <https://doi.org/10.1016/j.bja.2021.04.026>. 10.1016/j.bja.2021.04.026
institution Universiti Malaya
building UM Library
collection Institutional Repository
continent Asia
country Malaysia
content_provider Universiti Malaya
content_source UM Research Repository
url_provider http://eprints.um.edu.my/
topic R Medicine
RA Public aspects of medicine
spellingShingle R Medicine
RA Public aspects of medicine
Ledowski, Thomas
Szabo-Maak, Zoltan
San Loh, Pui
Turlach, Berwin A.
Yang, Hong Seuk
de Boer, Hans D.
Asztalos, Laszlo
Shariffuddin, Ina Ismiarti
Chan, Lucy
Fulesdi, Bela
Reversal of residual neuromuscular block with neostigmine or sugammadex and postoperative pulmonary complications: A prospective, randomised, double-blind trial in high-risk older patients
description Residual neuromuscular block is associated with an increased risk of postoperative pulmonary complications in retrospective studies. The aim of our study was to investigate prospectively the incidence of postoperative pulmonary complications after reversal with either sugammadex (SUG) or neostigmine (NEO) in high-risk older patients. Methods: We randomly allocated 180 older patients with significant morbidity (ASA physical status 3) >= 75 yr old to reversal of rocuronium with either SUG or NEO. Adverse events in the recovery room and pulmonary complications (defined by a 5-point 0-4; 0= best to 4= worst] outcome score) on postoperative Days 1, 3, and 7 were compared between groups. Results: Data from 168 patients aged 80 (4) yr were analysed; SUG vs NEO resulted in a reduced probability (0.052 vs 0.122) of increased pulmonary outcome score (impaired outcome) on postoperative Day 7, but not on Days 1 and 3. More patients in the NEO group were diagnosed with radiographically confirmed pneumonia (9.6% vs 2.4%; P=0.046). The NEO group showed a non-significant trend towards longer hospital length of stay across all individual centres (combined 9 vs 7.5 days), with a significant difference in Malaysia (6 vs 4 days; P=0.011). Conclusions: Reversal of rocuronium neuromuscular block with SUG resulted in a small, but possibly clinically relevant improvement in pulmonary outcome in a select cohort of high-risk older patients.
format Article
author Ledowski, Thomas
Szabo-Maak, Zoltan
San Loh, Pui
Turlach, Berwin A.
Yang, Hong Seuk
de Boer, Hans D.
Asztalos, Laszlo
Shariffuddin, Ina Ismiarti
Chan, Lucy
Fulesdi, Bela
author_facet Ledowski, Thomas
Szabo-Maak, Zoltan
San Loh, Pui
Turlach, Berwin A.
Yang, Hong Seuk
de Boer, Hans D.
Asztalos, Laszlo
Shariffuddin, Ina Ismiarti
Chan, Lucy
Fulesdi, Bela
author_sort Ledowski, Thomas
title Reversal of residual neuromuscular block with neostigmine or sugammadex and postoperative pulmonary complications: A prospective, randomised, double-blind trial in high-risk older patients
title_short Reversal of residual neuromuscular block with neostigmine or sugammadex and postoperative pulmonary complications: A prospective, randomised, double-blind trial in high-risk older patients
title_full Reversal of residual neuromuscular block with neostigmine or sugammadex and postoperative pulmonary complications: A prospective, randomised, double-blind trial in high-risk older patients
title_fullStr Reversal of residual neuromuscular block with neostigmine or sugammadex and postoperative pulmonary complications: A prospective, randomised, double-blind trial in high-risk older patients
title_full_unstemmed Reversal of residual neuromuscular block with neostigmine or sugammadex and postoperative pulmonary complications: A prospective, randomised, double-blind trial in high-risk older patients
title_sort reversal of residual neuromuscular block with neostigmine or sugammadex and postoperative pulmonary complications: a prospective, randomised, double-blind trial in high-risk older patients
publisher Elsevier Sci Ltd
publishDate 2021
url http://eprints.um.edu.my/34363/
_version_ 1744649174788341760
score 13.211869

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