학술논문
Neuromuscular blockade management and postoperative outcomes in enhanced recovery colorectal surgery: secondary analysis of POWER trial.
Document Type
Academic Journal
Author
Serrano AB; Department of Anesthesiology, Ramón y Cajal University Hospital, Madrid, Spain - anab_serrano@yahoo.es.; Instituto de Investigación Sanitaria Hospital Ramón y Cajal (IRYCIS), Madrid, Spain - anab_serrano@yahoo.es.; DÍaz-Cambronero Ó; Department of Anesthesiology, The University and Polytechnic La Fe Hospital of Valencia, Valencia, Spain.; Melchor-RipollÉs J; Department of Anesthesiology, Infanta Leonor University Hospital, Madrid, Spain.; Abad-Gurumeta A; Department of Anesthesiology, Infanta Leonor University Hospital, Madrid, Spain.; Ramirez-Rodriguez JM; Department of General Surgery, Lozano Blesa University Hospital, Zaragoza, Spain.; MartÍnez-Ubieto J; Department of Anesthesiology, Miguel Servet University Hospital, Zaragoza, Spain.; SÁnchez-Merchante M; Department of Anesthesiology, Fundación Alcorcón University Hospital, Madrid, Spain.; Rodriguez R; Department of Anesthesiology, University Clinical Hospital of Valladolid, Valladolid, Spain.; JordÁ L; Department of Anesthesiology, University General Hospital of Castellón, Castellón, Spain.; Gil-Trujillo S; Department of Anesthesiology, Hospital General Universitario de Ciudad Real (HGUCR), Ciudad Real, Spain.; Cabellos-Olivares M; Department of Anesthesiology, University Hospital of Guadalajara, Guadalajara, Spain.; Bordonaba-Bosque D; Institute for Health Sciences in Aragon (IACS), Centro de Investigación Biomédica de Aragón (CIBA), Zaragoza, Spain.; Aldecoa C; Department of Anesthesiology, University General Hospital of Castellón, Castellón, Spain.
Source
Publisher: [Edizioni Minerva Medica] Country of Publication: Italy NLM ID: 0375272 Publication Model: Print Cited Medium: Internet ISSN: 1827-1596 (Electronic) Linking ISSN: 03759393 NLM ISO Abbreviation: Minerva Anestesiol Subsets: MEDLINE
Subject
Language
English
Abstract
Background: We evaluated the impact of neuromuscular blockade (NMB) management, monitoring and reversal on postoperative outcomes in colorectal surgical patients included in an enhanced recovery program.
Methods: We performed a predefined analysis in 2084 patients undergoing elective colorectal surgery who participated in POWER study. We analyzed them for complications, length of hospital stay and mortality. Two groups were defined: 1) monitoring + reversal of the neuromuscular blockade (M+R) group: all patients receiving neuromuscular blockade monitoring plus reversal of it with any drug (neostigmine or sugammadex) were included; and 2) no monitoring nor reversal (noM+noR) group. In this group all the patients who did not receive monitoring and reversal of the neuromuscular blockade were allocated.
Results: Multivariate analysis found no statistically significant differences in moderate-severe complications (174 [25.7%] vs. 124 [27.1%]; P=0.607), length of hospital stay (10.8±11.1 vs. 11.0 ±12.6 days; P=0.683) and mortality (6 [0.9%] vs. 5 [1.1%]; P=0.840) between the group receiving optimal neuromuscular management (M+R) and the one did not receive it (noM+noR). Univariate analysis showed patients reversed with neostigmine died more than those reversed with sugammadex (3 [2.7%] vs. 3 [0.5%]; P=0.048).
Conclusions: Our data suggest optimal neuromuscular blockade management in colorectal surgery is not associated with less moderate-severe complications, length of hospital stay or death during postoperative period in an enhanced recovery program. Neostigmine reversal seems to be linked to higher rate of mortality than sugammadex.
Methods: We performed a predefined analysis in 2084 patients undergoing elective colorectal surgery who participated in POWER study. We analyzed them for complications, length of hospital stay and mortality. Two groups were defined: 1) monitoring + reversal of the neuromuscular blockade (M+R) group: all patients receiving neuromuscular blockade monitoring plus reversal of it with any drug (neostigmine or sugammadex) were included; and 2) no monitoring nor reversal (noM+noR) group. In this group all the patients who did not receive monitoring and reversal of the neuromuscular blockade were allocated.
Results: Multivariate analysis found no statistically significant differences in moderate-severe complications (174 [25.7%] vs. 124 [27.1%]; P=0.607), length of hospital stay (10.8±11.1 vs. 11.0 ±12.6 days; P=0.683) and mortality (6 [0.9%] vs. 5 [1.1%]; P=0.840) between the group receiving optimal neuromuscular management (M+R) and the one did not receive it (noM+noR). Univariate analysis showed patients reversed with neostigmine died more than those reversed with sugammadex (3 [2.7%] vs. 3 [0.5%]; P=0.048).
Conclusions: Our data suggest optimal neuromuscular blockade management in colorectal surgery is not associated with less moderate-severe complications, length of hospital stay or death during postoperative period in an enhanced recovery program. Neostigmine reversal seems to be linked to higher rate of mortality than sugammadex.