Çiğdem YILDIRIM GÜÇLÜ, Zekeriyya ALANOĞLU, Başak Ceyda MEÇO, Menekşe ÖZÇELİK, Sanem ÇAKAR TURHAN, Barış ADAKLI, Neslihan ALKIŞ

Nöromusküler Monitorizasyon Rehberliğinin Olmadığı Hastalarda, Sugammadex Ekstübasyon için Güvenilir bir Seçenek Midir? Randomize Klinik Çalışma

Amaç: Septorinoplasti uygulanan hastalarda, anestezi ve postoperatif bakım yönetimi, özellikle de ekstübasyonda nazal tampon nedeniyle zor olabilir. Bu hastalarda patent hava yolunun sağlanması kritik bir konudur. Bu çalışmada, nöromüsküler monitörizasyon yokluğunda, sugammadeksin ekstübasyon karakteristikleri değerlendirildi. Gereç ve Yöntem: Bu randomize, prospektif çalışmada, septorinoplasti yapılan 90 hasta, ekstübasyon için nöromüsküler monitörizasyon rehberliğinde veya olmaksızın, neostigmin veya sugammadeks ile geri döndürme için gruplara ayrıldı. İndüksiyon ve idame, tüm gruplar için standardizeydi ve gruplar geri döndürücü ajan ve nöromüsküler monitörizasyon varlığına göre farklılık gösterdi. Ekstübasyon koşulları kaydedildi. Ekstübasyon süresi ve anestezi sonrası bakım ünitesinde geçirilen süre de kaydedildi. Boğaz ağrısı, öksürük, ıkınma veya laringospazm gibi istenmeyen olaylar ameliyathanede ve anestezi sonrası bakım ünitesinden taburcu edilene kadar kaydedildi. Burun kanaması ve tampon değişikliği kaydedildi. Bulgular: Ortalama ekstübasyon süresi (reversal ajan uygulamasından ekstübasyona kadar geçen süre) ve anestezi sonrası bakım ünitesinde kalış süresi (Grup 1: 20,5±4,1 dakika (dk), Grup 2: 21,3±7,3 dk, Grup 3: 12 12,2±2,9 dk, Grup 4: 12,7±2,5 dakika) (p=0,001) sugammadeks gruplarında, neostigmin gruplarından anlamlı olarak daha kısaydı. Nöromüsküler monitörizasyondan bağımsız olarak, sugammadeks gruplarında neostigmin gruplarına kıyasla daha az hastaya maske ventilasyonu gerekti. Sonuç: Sugammadeks, objektif nöromüsküler monitörizasyondan bağımsız olarak, neostigminden daha uygun ekstübasyon koşulları sağlayabilir.

Is Sugammadex a Reliable Option for Extubation Conditions in Patients Without Neuromuscular Monitorisation Guidance? A Randomised Clinical Study

Objectives: In patients undergoing septorhinoplasty, anesthesia and management of postoperative care may be challenging, especially at extubation, due to nasal packing. Maintaining a patent airway is a critical issue in these patients. In this study, extubation characteristics of sugammadex in the absence of neuromuscular monitorization were evaluated. Materials and Methods: In this randomized, prospective trial, 90 patients who underwent septorhinoplasty were allocated to groups to reversal with either neostigmine or sugammadex, with or without neuromuscular monitorization guidance for extubation. The induction and maintenance were standardized for all groups and groups were differed according to the reversal agent and presence of neuromuscular monitorization. The extubation conditions were recorded. Extubation time and time spent in postanesthesia care unit were also recorded.Adverse events such as throat pain, cough, straining, or laryngospasm were recorded in the operating room and until discharge from the post anesthesia care unit. Nasal bleeding and change of packing were recorded. Results: The mean extubation time (time from the administration of reversal agent to extubation) and post anesthesia care unit stay time [Group 1: 20.5±4.1 minute (min), Group 2: 21.3±7.3 min, Group 3: 12 12.2±2.9 min, Group 4: 12.7±2.5 min] (p=0.001) were significantly shorter in the sugammadex groups than in the neostigmine groups. Number of patients in the sugammadex groups required less mask ventilation compared to the neostigmine groups, regardless of the neuromuscular monitorization. Conclusion: Sugammadex may provide favorable extubation conditions than neostigmine regardless of objective neuromuscular monitorization.

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