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Sugammadex Allows Fast-Track Bariatric Surgery

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Abstract

Background

Morbidly obese (MO) patients are at increased risk for postoperative anesthesia-related complications. We evaluated the role of sugammadex versus neostigmine in the quality of recovery from profound rocuronium-induced neuromuscular blockade (NMB) in patients with morbid obesity.

Methods

We studied 40 female MO patients who received desflurane and remifentanil anesthesia for laparoscopic removal of adjustable gastric banding. NMB was achieved with rocuronium. At the end of the surgical procedure, complete reversal of NMB was obtained with sugammadex (SUG group, n = 20) or neostigmine plus atropine (NEO group, n = 20) in the presence of profound NMB.

Results

No difference in surgical time or anesthetic drugs was found between the groups. Anesthesia time was significantly greater in the NEO group than in the SUG group (95 ± 21 vs. 47.9 ± 6.4 min, p < 0.0001), which was mainly due to a longer time to reach a train-of-four ratio (TOFR) ≥ 0.9 in the NEO group (48.6 ± 18 vs. 3.1 ± 1.3 min, p < 0.0001) during reversal of profound NMB. Upon admission to the postanesthesia care unit, level of SpO2 (p = 0.018), TOFR (p < 0.0001), ability to swallow (p = 0.0027), and ability to get into bed independently (p = 0.022) were better in the SUG group than in the NEO group. Patients in the SUG group were discharged to the surgical ward earlier than patients in the NEO group were (p = 0.013).

Conclusions

Sugammadex allowed a safer and faster recovery from profound rocuronium-induced NMB than neostigmine did in patients with MO. Sugammadex may play an important role in fast-track bariatric anesthesia

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Grant Information

The authors are supported by departmental funds only.

Implication

Findings from this study were presented as a poster at the 2012 International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) in New Delhi, India [Obes Surg 2012; 22: 1315-1419 (P034)].

Conflict of Interest

Michele Carron has received a payment for lecture from MSD; Mirto Foletto has received a payment for consultancy from Johnson & Johnson Medical; Carlo Ori has received payments and travel fundings for lectures and as a member of MSD Advisory Board.

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Authors and Affiliations

  1. Department of Medicine, Anesthesiology and Intensive Care, University of Padova, Via C. Battisti, 267-35121, Padua, Italy

    Michele Carron, Stefano Veronese & Carlo Ori

  2. Bariatric Unit, University of Padova, Via Giustiniani, 2-35128, Padua, Italy

    Mirto Foletto

Authors
  1. Michele Carron
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  2. Stefano Veronese
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  3. Mirto Foletto
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  4. Carlo Ori
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Corresponding author

Correspondence to Michele Carron.

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Carron, M., Veronese, S., Foletto, M. et al. Sugammadex Allows Fast-Track Bariatric Surgery. OBES SURG 23, 1558–1563 (2013). https://doi.org/10.1007/s11695-013-0926-y

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  • DOI: https://doi.org/10.1007/s11695-013-0926-y

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