Cargando…
Sugammadex versus neostigmine for neuromuscular blockade reversal in outpatient surgeries: A randomized controlled trial to evaluate efficacy and associated healthcare cost in an academic center
INTRODUCTION: Neuromuscular blockade is an essential component of the general anesthesia as it allows for a better airway management and optimal surgical conditions. Despite significant reductions in extubation and OR readiness-for-discharge times have been associated with the use of sugammadex, the...
Autores principales: | , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9772266/ https://www.ncbi.nlm.nih.gov/pubmed/36569123 http://dx.doi.org/10.3389/fmed.2022.1072711 |
_version_ | 1784854943444762624 |
---|---|
author | Fiorda Diaz, Juan Echeverria-Villalobos, Marco Esparza Gutierrez, Alan Dada, Olufunke Stoicea, Nicoleta Ackermann, Wiebke Abdel-Rasoul, Mahmoud Heard, Jarrett Uribe, Alberto Bergese, Sergio D. |
author_facet | Fiorda Diaz, Juan Echeverria-Villalobos, Marco Esparza Gutierrez, Alan Dada, Olufunke Stoicea, Nicoleta Ackermann, Wiebke Abdel-Rasoul, Mahmoud Heard, Jarrett Uribe, Alberto Bergese, Sergio D. |
author_sort | Fiorda Diaz, Juan |
collection | PubMed |
description | INTRODUCTION: Neuromuscular blockade is an essential component of the general anesthesia as it allows for a better airway management and optimal surgical conditions. Despite significant reductions in extubation and OR readiness-for-discharge times have been associated with the use of sugammadex, the cost-effectiveness of this drug remains controversial. We aimed to compare the time to reach a train-of-four (TOF) response of ≥0.9 and operating room readiness for discharge in patients who received sugammadex for moderate neuromuscular blockade reversal when compared to neostigmine during outpatient surgeries under general anesthesia. Potential reduction in time for OR discharge readiness as a result of sugammadex use may compensate for the existing cost-gap between sugammadex and neostigmine. METHODS: We conducted a single-center, randomized, double arm, open-label, prospective clinical trial involving adult patients undergoing outpatient surgeries under general anesthesia. Eligible subjects were randomized (1:1 ratio) into two groups to receive either sugammadex (Groups S), or neostigmine/glycopyrrolate (Group N) at the time of neuromuscular blockade reversal. The primary outcome was the time to reverse moderate rocuronium-induced neuromuscular blockade (TOF ratio ≥0.9) in both groups. In addition, post-anesthesia care unit (PACU)/hospital length of stay (LOS) and perioperative costs were compared among groups as secondary outcomes. RESULTS: Thirty-seven subjects were included in our statistical analysis (Group S= 18 subjects and Group N= 19 subjects). The median time to reach a TOF ratio ≥0.9 was significantly reduced in Group S when compared to Group N (180 versus 540 seconds; p = 0.0052). PACU and hospital LOS were comparable among groups. Postoperative nausea and vomiting was the main adverse effect reported in Group S (22.2% versus 5.3% in Group N; p = 0.18), while urinary retention (10.5%) and shortness of breath (5.3%) were only experienced by some patients in Group N. Moreover, no statistical differences were found between groups regarding OR/anesthesia, PACU, and total admission costs. DISCUSSION: Sugammadex use was associated with a significantly faster moderate neuromuscular blockade reversal. We found no evidence of increased perioperative costs associated with the use of sugammadex in patients undergoing outpatient surgeries in our academic institution. CLINICAL TRIAL REGISTRATION: [https://clinicaltrials.gov/] identifier number [NCT03579589]. |
format | Online Article Text |
id | pubmed-9772266 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-97722662022-12-23 Sugammadex versus neostigmine for neuromuscular blockade reversal in outpatient surgeries: A randomized controlled trial to evaluate efficacy and associated healthcare cost in an academic center Fiorda Diaz, Juan Echeverria-Villalobos, Marco Esparza Gutierrez, Alan Dada, Olufunke Stoicea, Nicoleta Ackermann, Wiebke Abdel-Rasoul, Mahmoud Heard, Jarrett Uribe, Alberto Bergese, Sergio D. Front Med (Lausanne) Medicine INTRODUCTION: Neuromuscular blockade is an essential component of the general anesthesia as it allows for a better airway management and optimal surgical conditions. Despite significant reductions in extubation and OR readiness-for-discharge times have been associated with the use of sugammadex, the cost-effectiveness of this drug remains controversial. We aimed to compare the time to reach a train-of-four (TOF) response of ≥0.9 and operating room readiness for discharge in patients who received sugammadex for moderate neuromuscular blockade reversal when compared to neostigmine during outpatient surgeries under general anesthesia. Potential reduction in time for OR discharge readiness as a result of sugammadex use may compensate for the existing cost-gap between sugammadex and neostigmine. METHODS: We conducted a single-center, randomized, double arm, open-label, prospective clinical trial involving adult patients undergoing outpatient surgeries under general anesthesia. Eligible subjects were randomized (1:1 ratio) into two groups to receive either sugammadex (Groups S), or neostigmine/glycopyrrolate (Group N) at the time of neuromuscular blockade reversal. The primary outcome was the time to reverse moderate rocuronium-induced neuromuscular blockade (TOF ratio ≥0.9) in both groups. In addition, post-anesthesia care unit (PACU)/hospital length of stay (LOS) and perioperative costs were compared among groups as secondary outcomes. RESULTS: Thirty-seven subjects were included in our statistical analysis (Group S= 18 subjects and Group N= 19 subjects). The median time to reach a TOF ratio ≥0.9 was significantly reduced in Group S when compared to Group N (180 versus 540 seconds; p = 0.0052). PACU and hospital LOS were comparable among groups. Postoperative nausea and vomiting was the main adverse effect reported in Group S (22.2% versus 5.3% in Group N; p = 0.18), while urinary retention (10.5%) and shortness of breath (5.3%) were only experienced by some patients in Group N. Moreover, no statistical differences were found between groups regarding OR/anesthesia, PACU, and total admission costs. DISCUSSION: Sugammadex use was associated with a significantly faster moderate neuromuscular blockade reversal. We found no evidence of increased perioperative costs associated with the use of sugammadex in patients undergoing outpatient surgeries in our academic institution. CLINICAL TRIAL REGISTRATION: [https://clinicaltrials.gov/] identifier number [NCT03579589]. Frontiers Media S.A. 2022-12-08 /pmc/articles/PMC9772266/ /pubmed/36569123 http://dx.doi.org/10.3389/fmed.2022.1072711 Text en Copyright © 2022 Fiorda Diaz, Echeverria-Villalobos, Esparza Gutierrez, Dada, Stoicea, Ackermann, Abdel-Rasoul, Heard, Uribe and Bergese. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Medicine Fiorda Diaz, Juan Echeverria-Villalobos, Marco Esparza Gutierrez, Alan Dada, Olufunke Stoicea, Nicoleta Ackermann, Wiebke Abdel-Rasoul, Mahmoud Heard, Jarrett Uribe, Alberto Bergese, Sergio D. Sugammadex versus neostigmine for neuromuscular blockade reversal in outpatient surgeries: A randomized controlled trial to evaluate efficacy and associated healthcare cost in an academic center |
title | Sugammadex versus neostigmine for neuromuscular blockade reversal in outpatient surgeries: A randomized controlled trial to evaluate efficacy and associated healthcare cost in an academic center |
title_full | Sugammadex versus neostigmine for neuromuscular blockade reversal in outpatient surgeries: A randomized controlled trial to evaluate efficacy and associated healthcare cost in an academic center |
title_fullStr | Sugammadex versus neostigmine for neuromuscular blockade reversal in outpatient surgeries: A randomized controlled trial to evaluate efficacy and associated healthcare cost in an academic center |
title_full_unstemmed | Sugammadex versus neostigmine for neuromuscular blockade reversal in outpatient surgeries: A randomized controlled trial to evaluate efficacy and associated healthcare cost in an academic center |
title_short | Sugammadex versus neostigmine for neuromuscular blockade reversal in outpatient surgeries: A randomized controlled trial to evaluate efficacy and associated healthcare cost in an academic center |
title_sort | sugammadex versus neostigmine for neuromuscular blockade reversal in outpatient surgeries: a randomized controlled trial to evaluate efficacy and associated healthcare cost in an academic center |
topic | Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9772266/ https://www.ncbi.nlm.nih.gov/pubmed/36569123 http://dx.doi.org/10.3389/fmed.2022.1072711 |
work_keys_str_mv | AT fiordadiazjuan sugammadexversusneostigmineforneuromuscularblockadereversalinoutpatientsurgeriesarandomizedcontrolledtrialtoevaluateefficacyandassociatedhealthcarecostinanacademiccenter AT echeverriavillalobosmarco sugammadexversusneostigmineforneuromuscularblockadereversalinoutpatientsurgeriesarandomizedcontrolledtrialtoevaluateefficacyandassociatedhealthcarecostinanacademiccenter AT esparzagutierrezalan sugammadexversusneostigmineforneuromuscularblockadereversalinoutpatientsurgeriesarandomizedcontrolledtrialtoevaluateefficacyandassociatedhealthcarecostinanacademiccenter AT dadaolufunke sugammadexversusneostigmineforneuromuscularblockadereversalinoutpatientsurgeriesarandomizedcontrolledtrialtoevaluateefficacyandassociatedhealthcarecostinanacademiccenter AT stoiceanicoleta sugammadexversusneostigmineforneuromuscularblockadereversalinoutpatientsurgeriesarandomizedcontrolledtrialtoevaluateefficacyandassociatedhealthcarecostinanacademiccenter AT ackermannwiebke sugammadexversusneostigmineforneuromuscularblockadereversalinoutpatientsurgeriesarandomizedcontrolledtrialtoevaluateefficacyandassociatedhealthcarecostinanacademiccenter AT abdelrasoulmahmoud sugammadexversusneostigmineforneuromuscularblockadereversalinoutpatientsurgeriesarandomizedcontrolledtrialtoevaluateefficacyandassociatedhealthcarecostinanacademiccenter AT heardjarrett sugammadexversusneostigmineforneuromuscularblockadereversalinoutpatientsurgeriesarandomizedcontrolledtrialtoevaluateefficacyandassociatedhealthcarecostinanacademiccenter AT uribealberto sugammadexversusneostigmineforneuromuscularblockadereversalinoutpatientsurgeriesarandomizedcontrolledtrialtoevaluateefficacyandassociatedhealthcarecostinanacademiccenter AT bergesesergiod sugammadexversusneostigmineforneuromuscularblockadereversalinoutpatientsurgeriesarandomizedcontrolledtrialtoevaluateefficacyandassociatedhealthcarecostinanacademiccenter |