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 T 1 , Szabó-Maák Z 2 , Loh PS 3 , Turlach BA 4 , Yang HS 5 , de Boer HD 6 Show all authors , Asztalos L 2 , Shariffuddin II 3 , Chan L 3 , Fülesdi B 2

Affiliations 

  • 1 Medical School, University of Western Australia, Perth, Australia; Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Australia. Electronic address: Thomas.ledowski@uwa.edu.au
  • 2 Department of Anaesthesiology and Intensive Care, University of Debrecen, Debrecen, Hungary
  • 3 Department of Anaesthesiology, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
  • 4 Centre of Applied Statistics, University of Western Australia, Perth, Australia
  • 5 Department of Anesthesiology and Pain Medicine, Eulji University, School of Medicine, DaejeonEulji University Hospital, Daejeon, Republic of Korea; College of Medicine, University of Ulsan, Seoul, Republic of Korea
  • 6 Department of Anaesthesiology, Pain Medicine and Procedural Sedation and Analgesia, Martini General Hospital, Groningen, the Netherlands
Br J Anaesth, 2021 08;127(2):316-323.
PMID: 34127252 DOI: 10.1016/j.bja.2021.04.026

Abstract

BACKGROUND: 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.

CLINICAL TRIAL REGISTRATION: ACTRN12614000108617.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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