scholarly journals Comparison of the Time to Extubation and Length of Stay in the PACU after Sugammadex and Neostigmine Use in Two Types of Surgery: A Monocentric Retrospective Analysis

2021 ◽  
Vol 10 (4) ◽  
pp. 815
Author(s):  
Cyrus Motamed ◽  
Jean Louis Bourgain
Keyword(s):  
Abdominal Surgery ◽  
Retrospective Analysis ◽  
Operating Room ◽  
Exit Time ◽  
Real Life ◽  
Pulmonary Complications ◽  
Recovery Unit ◽  
Extubation Time ◽  
Train Of Four ◽  
Pacu Stay

Sugammadex provides a rapid pharmacological reversal of aminosteroid, as well as fewer pulmonary complications, a better physiological recovery, and shorter stays in the postanesthetic recovery unit (PACU). This retrospective analysis of our Centricity anesthesia database in 2017–2019 assessed the efficiency of sugammadex in real-life situations in two groups of surgical cancer patients (breast and abdominal surgery) based on the extubation time, operating room exit time, and length of PACU stay. Overall, 382 anesthesia records (131 breast and 251 abdominal surgeries) were extracted for the pharmacological reversal of neuromuscular blockades by neostigmine or sugammadex. Sugammadex was used for reversal in 91 breast and 204 abdominal surgeries. Sugammadex use did not affect the extubation time, operating room exit time, or length of PACU stay. However, the time to reach a 90% train of four (TOF) recovery was significantly faster in sugammadex patients: 2 min (1.5–8) in breast surgery and 2 min (1.5–7) in abdominal surgery versus 10 (6–20) and 9 min (5–20), respectively, for neostigmine (p < 0.05). Most patients who were reversed with sugammadex (91%) reached a TOF ratio of at least 90%, while 54% of neostigmine patients had a 90% TOF ratio recorded (p < 0.05). Factors other than pharmacological reversal probably influence the extubation time, operating room exit time, or PACU stay; however, sugammadex reliably shortened the time so as to reach a 90% TOF ratio with a better level of reversal.

scholarly journals Sugammadex administration shortens reversal times but not operating room turnover times

2019 ◽  
Vol 5 (1) ◽  
pp. 27
Author(s):  
Garrett Enten ◽  
Michael Albrink ◽  
Jin Deng ◽  
Giorgio Melloni ◽  
Enrico M. Camporesi ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Operating Room ◽  
Outcome Measures ◽  
The Other ◽  
Muscle Paralysis ◽  
Or Efficiency ◽  
Reversal Agents ◽  
Reversal Time ◽  
Train Of Four ◽  
Complete Reversal

Objective: Current literature debates whether administration of sugammadex translates into a higher operating room (OR) efficiency when compared to neostigmine. This study is a blinded assessment of the effects of sugammadex versus neostigmine on OR efficiency as determined by time of reversal to time of the next case.Methods: 50 patients undergoing abdominal surgery were randomized and evenly distributed into two groups, one receiving sugammadex (4 mg/kg) and the other, neostigmine (0.06 mg/kg) plus glycopyrrolate (0.004 mg/kg). Muscle paralysis was induced with intravenous rocuronium (0.6 mg/kg). Train of four (TOF) was monitored using acceleromyography every 10 minutes until reversal. Reversal agents were blindly prepared and administered during closing. TOF was then recorded every minute until a T4/T1 ratio ≥ 0.9 was achieved. This was designated as time of complete reversal. Subsequently, post-reversal outcome measures were collected.Results: Patients receiving sugammadex experienced a significantly shorter reversal time compared to those receiving neostigmine and glycopyrrolate (2.92 ± 1.71 minutes vs. 7.68 ± 5.63 minutes; p = .0002). No other outcome measures were significantly different between groups: time of OR ready for next case was 55.4 min vs. 56.1 min respectively; not significant.Conclusions: While sugammadex was significantly faster at reversing patient neuromuscular blockade the time from reversal to patient extubation after Sugammadex was prolonged. . This could be due to blinding, as blinded providers are unable to anticipate time of reversal and must compensate by making decisions at safe fixed intervals. This is reflected in that the time gained by administration of sugammadex is approximately equal to the delay experienced across all endpoints collected to the patients’ actual discharge.

scholarly journals The Association of Intraoperative driving pressure with postoperative pulmonary complications in open versus closed abdominal surgery patients – a posthoc propensity score–weighted cohort analysis of the LAS VEGAS study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Guido Mazzinari ◽  
◽  
Ary Serpa Neto ◽  
Sabrine N. T. Hemmes ◽  
Goran Hedenstierna ◽  
...  
Keyword(s):  
Propensity Score ◽  
Adverse Events ◽  
Abdominal Surgery ◽  
Las Vegas ◽  
Cohort Analysis ◽  
Risk Difference ◽  
Pulmonary Complications ◽  
Driving Pressure ◽  
Postoperative Pulmonary Complications ◽  
Open Abdominal Surgery

Abstract Background It is uncertain whether the association of the intraoperative driving pressure (ΔP) with postoperative pulmonary complications (PPCs) depends on the surgical approach during abdominal surgery. Our primary objective was to determine and compare the association of time–weighted average ΔP (ΔPTW) with PPCs. We also tested the association of ΔPTW with intraoperative adverse events. Methods Posthoc retrospective propensity score–weighted cohort analysis of patients undergoing open or closed abdominal surgery in the ‘Local ASsessment of Ventilatory management during General Anaesthesia for Surgery’ (LAS VEGAS) study, that included patients in 146 hospitals across 29 countries. The primary endpoint was a composite of PPCs. The secondary endpoint was a composite of intraoperative adverse events. Results The analysis included 1128 and 906 patients undergoing open or closed abdominal surgery, respectively. The PPC rate was 5%. ΔP was lower in open abdominal surgery patients, but ΔPTW was not different between groups. The association of ΔPTW with PPCs was significant in both groups and had a higher risk ratio in closed compared to open abdominal surgery patients (1.11 [95%CI 1.10 to 1.20], P <  0.001 versus 1.05 [95%CI 1.05 to 1.05], P <  0.001; risk difference 0.05 [95%CI 0.04 to 0.06], P <  0.001). The association of ΔPTW with intraoperative adverse events was also significant in both groups but had higher odds ratio in closed compared to open abdominal surgery patients (1.13 [95%CI 1.12– to 1.14], P <  0.001 versus 1.07 [95%CI 1.05 to 1.10], P <  0.001; risk difference 0.05 [95%CI 0.030.07], P <  0.001). Conclusions ΔP is associated with PPC and intraoperative adverse events in abdominal surgery, both in open and closed abdominal surgery. Trial registration LAS VEGAS was registered at clinicaltrials.gov (trial identifier NCT01601223).

Use of Incentive Spirometry in Adults following Cardiac, Thoracic, and Upper Abdominal Surgery to Prevent Post-Operative Pulmonary Complications: A Systematic Review and Meta-Analysis

Respiration ◽  
2021 ◽  
pp. 1-14
Author(s):  
Kerrie A. Sullivan ◽  
Isabella F. Churchill ◽  
Danielle A. Hylton ◽  
Waël C. Hanna
Keyword(s):  
Abdominal Surgery ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
Pulmonary Complications ◽  
Adult Patients ◽  
Controlled Trials ◽  
Upper Abdominal Surgery ◽  
Upper Abdominal ◽  
Incentive Spirometry ◽  
Rehabilitation Strategies

<b><i>Background:</i></b> Currently, consensus on the effectiveness of incentive spirometry (IS) following cardiac, thoracic, and upper abdominal surgery has been based on randomized controlled trials (RCTs) and systematic reviews of lower methodological quality. To improve the quality of the research and to account for the effects of IS following thoracic surgery, in addition to cardiac and upper abdominal surgery, we performed a meta-analysis with thorough application of the Grading of Recommendations Assessment, Development and Evaluation scoring system and extensive reference to the Cochrane Handbook for Systematic Reviews of Interventions. <b><i>Objective:</i></b> The objective of this study was to determine, with rigorous methodology, whether IS for adult patients (18 years of age or older) undergoing cardiac, thoracic, or upper abdominal surgery significantly reduces30-day post-operative pulmonary complications (PPCs), 30-day mortality, and length of hospital stay (LHS) when compared to other rehabilitation strategies. <b><i>Methods:</i></b> The literature was searched using Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, and Web of Science for RCTs between the databases’ inception and March 2019. A random-effect model was selected to calculate risk ratios (RRs) with 95% confidence intervals (CIs). <b><i>Results:</i></b> Thirty-one RCTs involving 3,776 adults undergoing cardiac, thoracic, or upper abdominal surgery were included. By comparing the use of IS to other chest rehabilitation strategies, we found that IS alone did not significantly reduce 30-day PPCs (RR = 1.00, 95% CI: 0.88–1.13) or 30-day mortality (RR = 0.73, 95% CI: 0.42–1.25). Likewise, there was no difference in LHS (mean difference = −0.17,95% CI: −0.65 to 0.30) between IS and the other rehabilitation strategies. None of the included trials significantly impacted the sensitivity analysis and publication bias was not detected. <b><i>Conclusions:</i></b> This meta-analysis showed that IS alone likely results in little to no reduction in the number of adult patients with PPCs, in mortality, or in the LHS, following cardiac, thoracic, and upper abdominal surgery.

Comparison of Lung Expansion Techniques on Thoracoabdominal Mechanics and Incidence of Pulmonary Complications After Upper Abdominal Surgery

CHEST Journal ◽  
2015 ◽  
Vol 148 (4) ◽  
pp. 1003-1010 ◽  
Author(s):  
Adriana C. Lunardi ◽  
Denise M. Paisani ◽  
Cibele C. B. Marques da Silva ◽  
Desiderio P. Cano ◽  
Clarice Tanaka ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Pulmonary Complications ◽  
Upper Abdominal Surgery ◽  
Lung Expansion ◽  
Upper Abdominal

Residual Neuromuscular Block in HIV-Infected Young Patients: A Prospective Observational Study

2021 ◽  
Author(s):  
Ruixue hou ◽  
Liangyu wu ◽  
Yadong liu ◽  
Fangfang miao ◽  
Cheng yin ◽  
...  
Keyword(s):  
Reaction Time ◽  
Neuromuscular Block ◽  
Young Patients ◽  
Onset Time ◽  
Pulmonary Complications ◽  
Infected Group ◽  
Normal Group ◽  
Postanesthesia Care Unit ◽  
Residual Neuromuscular Blockade ◽  
Train Of Four

Abstract Objectives: Avoidance of residual neuromuscular blockade (RNMB) is crucial to decrease anesthesia-related pulmonary complications. At present, no data are available for HIV-infected patients about the occurrence of RNMB. In this trial, we aim to investigate the incidence of RNMB in such patients. Methods: Data were prospectively collected on 45 normal and 45 HIV-infected patients (18-65 yr). The train-of-four stimulation (TOF-Watch SX) was used to evaluate the level of neuromuscular block from the induction of anesthesia to back to the postanesthesia care unit (PACU) by an assessor, but blind to the anesthesiologist. Primary endpoint was the presence of RNMB at PACU admission, defined as a train-of-four (TOF) ratio < 0.9. The onset time (from application of cisatracurium to maximum depression of T1), no reaction time (from zero of T1 to non-zero), and clinical duration (from application to 25% recovery of T1) were determined for each patient. Results: The incidence of RNMB was 37.5% in HIV- infected patients and 32.5% in normal patients (difference, 5%; 99% CI, −16% to 26 1%; p=0.815). The onset time was no different between two groups (4.05±0.88 min in HIV-infected group vs. 3.85±1.08 min in normal group (p=0.37)). The no reaction time was also similarly between two groups ( 49.83±3.81min in HIV-infected group vs. 48.98±5.12min in normal group (p=0.40)). The clinical duration was 53.78±3.05 min and 52.40±5.02 min in HIV-infected group and normal group, respectively (p=0.14). Conclusion: The odds of RNMB were not significantly different in HIV-infected young patients compared to normal persons.

scholarly journals 6 Minute Walk Test (6-MWT) as a Tool for Predicting Post Operative Pulmonary Complications in Abdominal Surgeries

2021 ◽  
pp. 204-209
Author(s):  
K. Janani ◽  
K. Rajkumaran ◽  
S. Niranjani
Keyword(s):  
Abdominal Surgery ◽  
Pulmonary Complication ◽  
Tertiary Care ◽  
Pulmonary Complications ◽  
Uncontrolled Hypertension ◽  
Walk Test ◽  
Coronary Syndrome ◽  
Six Minute Walk Test ◽  
6 Minute Walk Test ◽  
Minute Walk

Background: Post operative pulmonary complications (PPC) contribute to increased morbidity and mortality. Thus pre operative assessment is required. Six minute walk test (6-MWT) is a simple and reliable test which is recently being included in pre operative evaluation. Objectives: The objective of this study is to determine the value of the six minute walk test as a reliable tool in detecting post operative pulmonary complications in patients undergoing abdominal surgery. Materials and Methods: It is a prospective observational study conducted in a tertiary care centre for a period of 3 months. 66 patients in the age group of 40-60 years undergoing elective abdominal surgery under general anaesthesia were included in this study based on universal sampling method. Patients with recent coronary syndrome, uncontrolled hypertension, cardiac diseases, pregnancy and conditions which impair walking (eg. Arthiritis) were excluded from the study.     6 minute walk test was performed before the surgery. The procedure was explained to the patients and consent was obtained. The test was conducted on a flat surface of 20m near our pre anaesthetic clinic and the patient was asked to walk for a period of 6 minutes in their own comfortable pace. The distance covered by the patients in the 6 minutes was noted. Vitals such a SpO2, heart rate, systolic and diastolic blood pressures were recorded before and after the test. The patients were followed up for the development of pulmonary complications in the post operative period. Results: Out of the 66 patients included in the study, 35 patients did not develop        PPC (Group 1) and 31 patients developed PPC (Group2) including one death due to respiratory failure. The six minute walk distance in the PPC group was significantly less (p=0.0001) when compared to that of the non PPC group. Patients in the PPC group also required prolonged hospital stay. Pneumonia was the most commonly developed post operative pulmonary complication. Conclusion: Six minute walk test is a useful tool in predicting post operative pulmonary complication in patients undergoing abdominal surgery.  

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