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Rocuronium reversed by sugammadex versus mivacurium during high-risk eye surgery: an institutional anaesthetic
Susanne von Quillfeldt1, Bettina Föhre, Nicolai Andrees
1Department of Anesthesiology and Intensive Care Medicine CCM / CVK, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Objective:
This institutional anaesthetic practice evaluation compared patient safety with respect to residual neuromuscular blockade (NMB) at the time of tracheal extubation in patients undergoing high-risk eye surgery.
Methods:
Two muscle relaxation regimens were compared: rocuronium administered via intravenous (i.v.) bolus dosing combined with reversal through sugammadex at end of surgery (group R/S; 17 patients); mivacurium administered via continuous i.v. infusion without antagonization (group M; 22 patients). Train-of-four (TOF) monitoring determined the depth of NMB.
Results:
The TOF ratio at the time of tracheal extubation was greater in group R/S (median 1.03) than in group M (median 0.62). Time from end of surgery to tracheal extubation was not significantly different. The surgeons were 100% satisfied with the working conditions provided under both relaxation regimens.
Conclusions:
Residual postoperative curarization at the time of extubation was frequently observed in group M, whereas there was complete recovery in group R/S. Reversal of NMB by sugammadex provides an additional safety dimension to patient care and should thus be considered especially for those at risk of airway complications or aspiration, in addition to frail patients.
Insights
Sugammadex reversal of neuromuscular blockade (NMB) with rocuronium ensured complete recovery in high-risk eye surgery patients. Mivacurium infusion without reversal frequently resulted in residual NMB at extubation.
Area of Science:
- Anesthesiology
- Patient Safety
- Pharmacology
Background:
- Residual neuromuscular blockade (NMB) is a concern during tracheal extubation.
- High-risk eye surgery requires careful anesthetic management to ensure patient safety.
Purpose of the Study:
- To compare patient safety regarding residual NMB at extubation.
- To evaluate two anesthetic regimens for high-risk eye surgery.
Main Methods:
- Rocuronium with sugammadex reversal (group R/S) vs. mivacurium infusion without reversal (group M).
- Train-of-four (TOF) monitoring used to assess NMB depth.
- 17 patients in R/S group, 22 in M group.
Main Results:
- TOF ratio at extubation was higher in R/S group (median 1.03) than M group (median 0.62).
- No significant difference in time from surgery end to extubation.
- Surgeons reported 100% satisfaction with working conditions in both groups.
Conclusions:
- Complete recovery from NMB occurred with sugammadex reversal (R/S group).
- Frequent residual curarization observed with mivacurium infusion (M group).
- Sugammadex reversal enhances patient safety, especially for high-risk patients.
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