ABSTRACT
Purpose. Bariatric surgery patients are at high risk of perioperative respiratory adverse events. We hypothesized that the use of sugammadex to reverse neuromuscular blockade could improve postoperative respiratory outcomes. Methods. Prospective observational series of consecutive patients scheduled for laparoscopic bariatric surgery in whom neuromuscular blockade was reverted with sugammadex were compared with a historical matched cohort of patients reverted with neostigmines. The necessity of postoperative mechanical ventilation or pathological changes in postoperative chest X-ray were two of the comparisons done. Results. We enrolled 160 patients in each group (Sugammadex - SG and Historical - HG). Two patients (mean, CI 95%), (1.25, 0.34-4.4) in the SG and five patients in the HG (mean, CI 95%), (3.13, 1.34-7.11) required mechanical ventilation immediately after surgery (p = 0.38, chi-square test). Significantly less chest X-ray postoperative changes were observed in the SG: 11 patients (6.9%) versus 26 patients (16.3%) in the HG (Odds ratio OR, CI 95%) (0.36, 0.18-0.8). Conclusion. Requirement of mechanical ventilation is not associated to the reversal agent employed. Less pathological postoperative chest X-ray changes were found in the group of patients whose neuromuscular blockade was reverted with sugammadex (AU)
Objetivos. Los pacientes candidatos a cirugía bariátrica presentan mayor riesgo de eventos respiratorios adversos. Nuestra hipótesis fue que la utilización de sugammadex para revertir el bloqueo neuromuscular podría mejorar los resultados postoperatorios desde el punto de vista respiratorio. Métodos. Se comparó una serie prospectiva de pacientes sometidos a cirugía bariátrica laparoscópica revertidos con sugammadex con una cohorte histórica cotejada de pacientes sometidos a la misma cirugía revertidos con neostigmina. Se compararon, entre otros datos, la necesidad de ventilación mecánica postoperatoria y la aparición de cambios radiológicos patológicos tras la operación. Resultados. Se incluyeron 160 pacientes en cada grupo (Sugammadex [SG] e Histórico HG). Dos pacientes (media 1,25%, IC 95% 0,34-4,4) en el SG y 5 en el HG (media 3,13%, IC 95% 1,34-7,11) precisaron ventilación mecánica inmediatamente después de la cirugía (p = 0,38 test chi-cuadrado). Se observaron significativamente menos cambios en la radiografía posoperatoria de tórax en el grupo SG que en el HG: 11 pacientes (6,9%) frente a 26 (16,3%) (odds ratio 0,36, IC 95% 0,18-0,8). Conclusión. Las necesidades de ventilación mecánica no se asocian al agente reversor empleado. Se observaron menos cambios patológicos en la radiografía postoperatoria de tórax en el grupo de pacientes cuyo bloqueo neuromuscular fue revertido con sugammadex (AU)
Subject(s)
Humans , Male , Female , Bariatric Surgery/methods , Laparoscopy/methods , Laparoscopy/trends , Laparoscopy , Neuromuscular Agents/metabolism , Neuromuscular Agents/therapeutic use , Neuromuscular Blocking Agents/metabolism , Neuromuscular Blocking Agents/therapeutic use , Neostigmine , Prospective Studies , Obesity, Morbid/drug therapy , Obesity, Morbid/surgery , Breath Tests , Respiration Disorders/complications , Respiration Disorders/drug therapy , Respiration Disorders/prevention & controlABSTRACT
PURPOSE: Bariatric surgery patients are at high risk of perioperative respiratory adverse events. We hypothesized that the use of sugammadex to reverse neuromuscular blockade could improve postoperative respiratory outcomes. METHODS: Prospective observational series of consecutive patients scheduled for laparoscopic bariatric surgery in whom neuromuscular blockade was reverted with sugammadex were compared with a historical matched cohort of patients reverted with neostigmines. The necessity of postoperative mechanical ventilation or pathological changes in postoperative chest X-ray were two of the comparisons done. RESULTS: We enrolled 160 patients in each group (Sugammadex - SG and Historical - HG). Two patients (mean, CI 95%), (1.25, 0.34-4.4) in the SG and five patients in the HG (mean, CI 95%), (3.13, 1.34-7.11) required mechanical ventilation immediately after surgery (p=0.38, chi-square test). Significantly less chest X-ray postoperative changes were observed in the SG: 11 patients (6.9%) versus 26 patients (16.3%) in the HG (Odds ratio OR, CI 95%) (0.36, 0.18-0.8). CONCLUSION: Requirement of mechanical ventilation is not associated to the reversal agent employed. Less pathological postoperative chest X-ray changes were found in the group of patients whose neuromuscular blockade was reverted with sugammadex.
