Reversal of neuromuscular block with neostigmine and sugammadex: a retrospective cohort study in two centers using different types of neuromuscular monitoring
Authors' conclusion
Despite guidelines for the TOF ratio before extubation, recommendations were not adequately respected and more vigilance is mandatory.
Study context
- Population
- Patients undergoing abdominal surgery under GA with rocuronium NMB, January 2017 through December 2020
- Participants
- 2,242 patients · 2 centers
- Exposure
- Center 1 vs center 2 for reversal with neostigmine or sugammadex
- Center 1n = 459
- Center 2n = 1,783
- Outcome
- Compliance with recommendations for NMB reversal (TOF ratio > 90% at extubation)
Methodological detailsbicentric, Data extracted from the Centricity anesthesia information management system
- Bicentric
- Data extracted from the Centricity anesthesia information management system
Main finding
As reported in the abstract
Extubation with TOF ratio > 90% after neostigmine
P < 0.001
Observational data: associations, not effects.
Further findings
Extubation with TOF ratio > 90% after sugammadex
P < 0.001
Neostigmine given while TOF ratio < 40%
| Outcome | P value |
|---|---|
| Mean TOF ratio after supramaximal threshold determinationHigher in center 1 | P < 0.001 |
Extubation with train-of-four (TOF) ratio > 90% after sugammadex
- Sugammadex given irrespective of number of TOF responses before reversal
Safety
- No side effect encountered
Original publication
Reversal of neuromuscular block with neostigmine and sugammadex: a retrospective cohort study in two centers using different types of neuromuscular monitoring. J Clin Monit Comput. Published 20 July 2024. doi:10.
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