Effect of sugammadex on chest radiographic abnormality in the early postoperative period after video-assisted thoracoscopic lobectomy
Effect of sugammadex on chest radiographic abnormality in the early postoperative period after video-assisted thoracoscopic lobectomy
Background/aim: Sugammadex, which offsets the effects of neuromuscular blocking agents (NMBs), has advantages over traditional reversal agents like pyridostigmine, as it enables fast and reliable recovery from neuromuscular blockade. This study compared the incidence of early postoperative chest radiographic abnormalities (CRA) between sugammadex (group S) and pyridostigmine (group P) following video-assisted thoracoscopic (VAT) lobectomy for lung cancer. Materials and methods: We performed a retrospective cohort analysis by reviewing the medical records of patients who underwent VAT lobectomy at a single university medical center. We defined the early postoperative CRA as a characteristic appearance on chest radiograph up to 2 days after surgery. Arterial blood gas analysis (ABGA), surgical time, anaesthesia time, extubation time, and the total dose of rocuronium were analysed. Postoperative nausea and vomiting (PONV) and pain scores were observed until 2 days after surgery. Results: A total of 257 patients underwent VAT lobectomy during the study period; 159 were included in the final analysis. Ninety patients received sugammadex while 69 received pyridostigmine. The incidence of early postoperative atelectasis was significantly lower in group S than in group P (26.7%, 95% CI: 17.5%‒35.8% and 43.5%, 95% CI: 31.8%‒55.2%, respectively, P = 0.013). The median dose of rocuronium was higher in group S than in group P (120 mg vs. 90 mg, P < 0.001). ABGA, extubation time, and PONV were similar in both groups. Conclusion: Sugammadex decreased the incidence of CRA in the early postoperative period despite higher NMB consumption.
___
- 1. Gopaldas RR, Bakaeen FG, Dao TK, Walsh GL, Swisher SG et al. Video-assisted thoracoscopic versus open thoracotomy lobectomy in a cohort of 13,619 patients. Annals of Thoracic Surgery 2010; 89 (5): 1563-1570. doi: 10.1016/j. athoracsur.2010.02.026
- 2. Flores RM, Park BJ, Dycoco J, Aronova A, Hirth Y et al. Lobectomy by video-assisted thoracic surgery (VATS) versus thoracotomy for lung cancer. Journal of Thoracic and Cardiovascular Surgery 2009; 138 (1): 11-18. doi: 10.1016/j.jtcvs.2009.03.030
- 3. Boffa DJ, Dhamija A, Kosinski AS, Kim AW, Detterbeck FC et al. Fewer complications result from a video-assisted approach to anatomic resection of clinical stage I lung cancer. Journal of Thoracic and Cardiovascular Surgery 2014; 148 (2): 637-643. doi: 10.1016/j.jtcvs.2013.12.045
- 4. Gonzalez-Rivas D, Fieira E, Mendez L, Garcia J. Single-port video-assisted thoracoscopic anatomic segmentectomy and right upper lobectomy. European Journal of Cardio-Thoracic Surgery 2012; 42 (6): e169-171. doi: 10.1093/ejcts/ezs482
- 5. Gonzalez-Rivas D, Paradela M, Fernandez R, Delgado M, Fieira E et al. Uniportal video-assisted thoracoscopic lobectomy: two years of experience. Annals of Thoracic Surgery 2013; 95 (2): 426-432. doi: 10.1016/j.athoracsur.2012.10.070
- 6. Kim HK, Choi YH. The feasibility of single-incision videoassisted thoracoscopic major pulmonary resection performed by surgeons experienced with a two-incision technique. Interactive Cardiovascular and Thoracic Surgery 2015; 20 (3): 310-315. doi: 10.1093/icvts/ivu405
- 7. Ng CS, Kim HK, Wong RH, Yim AP, Mok TS et al. SinglePort Video-Assisted Thoracoscopic Major Lung Resections: Experience with 150 Consecutive Cases. Thoracic and Cardiovascular Surgeon 2016; 64 (4): 348-353. doi: 10.1055/s0034-1396789
- 8. Yang W, Zhang G, Pan S, Wang Z, Li J et al. Comparison of the perioperative efficacy between single-port and two-port video-assisted thoracoscopic surgery anatomical lung resection for non-small cell lung cancer: a systematic review and metaanalysis. Journal of Thoracic Disease 2019; 11 (7): 2763-2773. doi: 10.21037/jtd.2019.07.12
- 9. Assaad S, Popescu W, Perrino A. Fluid management in thoracic surgery. Current Opinion in Anaesthesiology 2013; 26 (1): 31-39. doi: 10.1097/ACO.0b013e32835c5cf5
- 10. Miskovic A, Lumb A. Postoperative pulmonary complications. British Journal of Anaesthesia 2017; 118 (3): 317-334. doi: 10.1093/bja/aex002
- 11. Kim KS, Lew SH, Cho HY, Cheong MA. Residual paralysis induced by either vecuronium or rocuronium after reversal with pyridostigmine. Anesthesia & Analgesia 2002; 95 (6): 1656-1660. doi: 10.1097/00000539-200212000-00033
- 12. Brueckmann B, Sasaki N, Grobara P, Li MK, Woo T et al. Effects of sugammadex on incidence of postoperative residual neuromuscular blockade: a randomized, controlled study. British Journal of Anaesthesia 2015; 115 (5): 743-751. doi: 10.1093/bja/ aev104
- 13. Gaszynski T, Szewczyk T, Gaszynski W. Randomized comparison of sugammadex and neostigmine for reversal of rocuronium-induced muscle relaxation in morbidly obese undergoing general anaesthesia. British Journal of Anaesthesia 2012; 108 (2): 236-239. doi: 10.1093/bja/aer330
- 14. Fiekers JF. Concentration-dependent effects of neostigmine on the endplate acetylcholine receptor channel complex. Journal of Neuroscience 1985; 5 (2): 502-514.
- 15. Nicholson WT, Sprung J, Jankowski CJ. Sugammadex: a novel agent for the reversal of neuromuscular blockade. Pharmacotherapy 2007; 27 (8): 1181-1188. doi: 10.1592/ phco.27.8.1181
- 16. Buuren Sv, Groothuis-Oudshoorn K. mice: Multivariate imputation by chained equations in R. Journal of Statistical Software 2011; 45 (3): 1-68. doi: 10.18637/jss.v045.i03
- 17. Honaker J, King G, Blackwell M. Amelia II: A program for missing data. Journal of Statistical Software 2011; 45 (7): 1-47. doi: 10.18637/jss.v045.i07
- 18. Agostini PJ, Lugg ST, Adams K, Smith T, Kalkat MS et al. Risk factors and short-term outcomes of postoperative pulmonary complications after VATS lobectomy. Journal of Cardiothoracic Surgery 2018; 13 (1): 28. doi: 10.1186/s13019-018-0717-6
- 19. Sengupta S. Post-operative pulmonary complications after thoracotomy. Indian Journal of Anaesthesia 2015; 59 (9): 618- 626. doi: 10.4103/0019-5049.165852
- 20. Rosenberg J, Ullstad T, Rasmussen J, Hjorne FP, Poulsen NJ et al. Time course of postoperative hypoxaemia. European Journal of Surgery 1994; 160 (3): 137-143.
- 21. Powell JF, Menon DK, Jones JG. The effects of hypoxaemia and recommendations for postoperative oxygen therapy. Anaesthesia 1996; 51 (8): 769-772. doi: 10.1111/j.1365- 2044.1996.tb07893.x
- 22. Engoren M. Lack of association between atelectasis and fever. Chest 1995; 107 (1): 81-84. doi: 10.1378/chest.107.1.81
- 23. Stolz AJ, Schutzner J, Lischke R, Simonek J, Harustiak T et al. Predictors of atelectasis after pulmonary lobectomy. Surgery Today 2008; 38 (11): 987-992. doi: 10.1007/s00595-008-3767-x
- 24. Wahba RM. Airway closure and intraoperative hypoxaemia: twenty-five years later. Canadian Journal of Anaesthesia 1996; 43 (11): 1144-1149. doi: 10.1007/BF03011842
- 25. Martinez-Ubieto J, Ortega-Lucea S, Pascual-Bellosta A, Arazo-Iglesias I, Gil-Bona J et al. Prospective study of residual neuromuscular block and postoperative respiratory complications in patients reversed with neostigmine versus sugammadex. Minerva Anestesiologica 2016; 82 (7): 735-742.
- 26. Cammu G, Smet V, De Jongh K, Vandeput D. A prospective, observational study comparing postoperative residual curarisation and early adverse respiratory events in patients reversed with neostigmine or sugammadex or after apparent spontaneous recovery. Anaesthesia and Intensive Care 2012; 40 (6): 999-1006. doi: 10.1177/0310057X1204000611
- 27. Ledowski T, Falke L, Johnston F, Gillies E, Greenaway M et al. Retrospective investigation of postoperative outcome after reversal of residual neuromuscular blockade: sugammadex, neostigmine or no reversal. European Journal of Anaesthesiology 2014; 31 (8): 423-429. doi: 10.1097/ EJA.0000000000000010
- 28. Imperatori A, Rotolo N, Gatti M, Nardecchia E, De Monte L et al. Peri-operative complications of video-assisted thoracoscopic surgery (VATS). International Journal of Surgery 2008; 6 Suppl 1: S78-81. doi: 10.1016/j.ijsu.2008.12.014
- 29. McLean DJ, Diaz-Gil D, Farhan HN, Ladha KS, Kurth T et al. Dose-dependent Association between Intermediateacting Neuromuscular-blocking Agents and Postoperative Respiratory Complications. Anesthesiology 2015; 122 (6): 1201-1213. doi: 10.1097/ALN.0000000000000674