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

Thomas Ledowski; Zoltan Szabó-Maák; Pui San Loh; Berwin A Turlach; Hong Seuk Yang; Hans D de Boer; László Asztalos; Ina Ismiarti Shariffuddin; Lucy Chan; Béla Fülesdi

doi:10.1016/j.bja.2021.04.026

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

Thomas Ledowski, Zoltan Szabó-Maák, Pui San Loh, Berwin A Turlach, Hong Seuk Yang, Hans D de Boer, László Asztalos, Ina Ismiarti Shariffuddin, Lucy Chan, Béla Fülesdi

Research output: Contribution to journal › Article › peer-review

1 Citation (Scopus)

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.

Original language	English
Journal	British Journal of Anaesthesia
DOIs	https://doi.org/10.1016/j.bja.2021.04.026
Publication status	E-pub ahead of print - 12 Jun 2021

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Ledowski, T., Szabó-Maák, Z., Loh, P. S., Turlach, B. A., Yang, H. S., de Boer, H. D., Asztalos, L., Shariffuddin, I. I., Chan, L., & Fülesdi, B. (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. https://doi.org/10.1016/j.bja.2021.04.026

Ledowski, Thomas ; Szabó-Maák, Zoltan ; Loh, Pui San ; Turlach, Berwin A ; Yang, Hong Seuk ; de Boer, Hans D ; Asztalos, László ; Shariffuddin, Ina Ismiarti ; Chan, Lucy ; Fülesdi, Béla. / Reversal of residual neuromuscular block with neostigmine or sugammadex and postoperative pulmonary complications : a prospective, randomised, double-blind trial in high-risk older patients. In: British Journal of Anaesthesia. 2021.

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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",

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.",

keywords = "neostigmine, neuromuscular block, perioperative complications, postoperative pulmonary complications, reversal, sugammadex",

author = "Thomas Ledowski and Zoltan Szab{\'o}-Ma{\'a}k and Loh, {Pui San} and Turlach, {Berwin A} and Yang, {Hong Seuk} and {de Boer}, {Hans D} and L{\'a}szl{\'o} Asztalos and Shariffuddin, {Ina Ismiarti} and Lucy Chan and B{\'e}la F{\"u}lesdi",

year = "2021",

month = jun,

day = "12",

doi = "10.1016/j.bja.2021.04.026",

language = "English",

journal = "British Journal of Anaesthesia",

issn = "0007-0912",

publisher = "Oxford University Press",

}

Ledowski, T, Szabó-Maák, Z, Loh, PS, Turlach, BA, Yang, HS, de Boer, HD, Asztalos, L, Shariffuddin, II, Chan, L & Fülesdi, B 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. https://doi.org/10.1016/j.bja.2021.04.026

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; Szabó-Maák, Zoltan; Loh, Pui San; Turlach, Berwin A; Yang, Hong Seuk; de Boer, Hans D; Asztalos, László; Shariffuddin, Ina Ismiarti; Chan, Lucy; Fülesdi, Béla.

In: British Journal of Anaesthesia, 12.06.2021.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Reversal of residual neuromuscular block with neostigmine or sugammadex and postoperative pulmonary complications

T2 - a prospective, randomised, double-blind trial in high-risk older patients

AU - Ledowski, Thomas

AU - Szabó-Maák, Zoltan

AU - Loh, Pui San

AU - Turlach, Berwin A

AU - Yang, Hong Seuk

AU - de Boer, Hans D

AU - Asztalos, László

AU - Shariffuddin, Ina Ismiarti

AU - Chan, Lucy

AU - Fülesdi, Béla

PY - 2021/6/12

Y1 - 2021/6/12

N2 - 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.

AB - 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.

KW - neostigmine

KW - neuromuscular block

KW - perioperative complications

KW - postoperative pulmonary complications

KW - reversal

KW - sugammadex

UR - http://www.scopus.com/inward/record.url?scp=85107868916&partnerID=8YFLogxK

U2 - 10.1016/j.bja.2021.04.026

DO - 10.1016/j.bja.2021.04.026

M3 - Article

C2 - 34127252

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

SN - 0007-0912

ER -

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

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