Neostigmine versus sugammadex on post-operative recovery following bariatric surgery

• Published in: Northern Clinics of Istanbul 2022-01, Vol.9 (4), p.311-316
• Main Authors: Ekinci, Osman, Gulmez, Duygu Demiriz, Subasi, Ferhunde Dilek, Ozgultekin, Asu, Demiroluk, Oznur
• Format: Article
• Language: English
• Subjects: Anesthesia; Anesthetics; Complications and side effects; Cooperation; Enzyme inhibitors; Extubation; Gastrointestinal surgery; Hemodynamics; Hypertension; Nausea; Neostigmine; Neuromuscular blocking agents; Obesity; Oxygen saturation; Patients; Postoperative period; Remifentanil; Respiratory failure; Surgery
• ISSN: 2148-4902; 2536-4553
• DOI: 10.14744/nci.2021.94715

OBJECTIVE: The purpose of our study was to compare the recovery characteristics and side effects of sugammadex (SM) and neostigmine (NT) in morbidly obese patients undergoing bariatric surgery. Residual neuromuscular block is a serious condition that increases pulmonary complications after anesthesia. Although acetylcholinesterase inhibitors help reverse this block, they may be insufficient, especially when administered with inhalational anesthetics. SM, a selective antagonist, may be more effective in reversing the block. METHODS: Patients were randomly divided into NT group (Group NT, n=34) and SM group (Group SM, n=34).For the induction, fentanil (1-1.5 [micro]/kg), propofol (2-3 mg/kg), and rocuronium (0.6 mg/kg) were used.For the maintenance, 50% [O.sub.2] + air, 1% sevoflurane, and remifentanil (0.5-0.3 [micro]g/kg/min) were used. Additional rocuronium was given to maintain the train of four (TOF) ratio [less than or equal to] 2. On completion of surgery and when the TOF ratio was 2, group NT received 50 [micro]g/kg of NT with 20 [micro]g/kg of atropine, whereas group SM received 2 mg/kg of SM. Hemodynamic parameters and peripheral oxygen saturation (Sp[O.sub.2]) were recorded every 10 minfirst, and every 5 min after the reversal agents were given. When the TOF ratio was 0.9 or higher, time to reach a TOF ratio of 0.9, and time to extubation were recorded. Patients were observed in the recovery room for 30 min for adverse effects. RESULTS: Demographic characteristics of the patients and total rocuronium use in two groups were similar (p>0.05).Time to extubation, time to TOF ratio of 0.9, time until patients responded to stimuli, time until cooperation, and time until orientation were significantly shorter in the SM group than in the NT group. Time to reach the Aldrete score of 9 was also significantly shorter in the SM group (p0.05). CONCLUSION: Considering the high risk of post-operative respiratory insufficiency inmorbidly obese patients, SM could be a safer choice in this patient group. Keywords: Bariatric surgery; NT, SM.