Warning: file_get_contents(https://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=41343719&cmd=llinks): Failed to open stream: HTTP request failed! HTTP/1.1 429 Too Many Requests
in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 215
Changes in intraoperative rocuronium dosing following the introduction of sugammadex and association with postoperative respiratory complications: A retrospective cohort study #MMPMID41343719
Wachtendorf LJ; Kaiser L; Ahrens E; Tenge T; Riesemann S; Xu X; Shay D; von Wedel D; Paschold BS; Chen G; Kiziltug H; Ramachandran SK; Fassbender PJ; Kienbaum P; Eikermann M; Schaefer MS
Anesthesiology 2025[Dec]; ? (?): ? PMID41343719show ga
BACKGROUND: Neuromuscular blocking agents dose-dependently precipitate residual neuromuscular blockade and postoperative respiratory complications. The introduction of sugammadex allowed for reversal of even deep neuromuscular blockade and might have provoked more liberal use of neuromuscular blocking agents. We investigated whether the introduction of sugammadex led to higher intraoperative rocuronium doses and whether this impacted postoperative respiratory complications. METHODS: 163,402 adult patient cases who underwent general anesthesia and received exclusively rocuronium at an academic medical center between 2010 and 2024 were included. Interrupted-time-series-analysis adjusted for patient and procedural characteristics was applied to assess changes in cumulative intraoperative rocuronium doses (mg/kg body-weight) following sugammadex introduction in September 2016. Rocuronium-associated risks of postoperative respiratory complications (post-extubation desaturation<90%, 7-day reintubation or emergency non-invasive ventilation) and effect modification by use of sugammadex and qualitative (twitch-count) versus quantitative (train-of-four-ratio) neuromuscular monitoring were evaluated. Reported odds ratios represent the dose-response association (per 1mg/kg rocuronium increase) within the respective subgroup of patient cases. RESULTS: Following a stable baseline (-0.01mg/kg per year between January 2010 and August 2016;95%CI -0.05-0.03mg/kg;p=0.58), rocuronium doses increased by 0.05mg/kg annually after introduction of sugammadex (95%CI 0.03-0.07mg/kg;p<0.001) from 0.83mg/kg (SD+/-0.49mg/kg) in August 2016 to 1.20mg/kg (SD+/-0.65mg/kg) in January 2024. 9,101 out of 108,317 patient cases (8.4%) experienced postoperative respiratory complications. Rocuronium was dose-dependently associated with higher postoperative respiratory complications risks, which was most pronounced among patient cases receiving neither sugammadex nor neuromuscular monitoring (ORadj1.99 per 1mg/kg;95%CI 1.82-2.18;p<0.001). This association was attenuated when sugammadex was administered (n=42,141;median dose 200mg; interquartile-range 200-300mg;ORadj1.08 per 1mg/kg;95%CI 1.01-1.16;p=0.023;p-for-interaction<0.001) and abolished with quantitative (n=25,564;ORadj0.94 per 1mg/kg;95%CI 0.85-1.03;p=0.19;p-for-interaction<0.001) but not qualitative neuromuscular monitoring (n=49,045;ORadj1.10 per 1mg/kg;95%CI 1.02-1.18;p=0.017;p-for-interaction<0.001). CONCLUSIONS: Sugammadex introduction was followed by a 45.1% increase in rocuronium doses. While sugammadex attenuated the risk of postoperative respiratory complications, it was only completely abolished with quantitative neuromuscular monitoring.
Anesthesiology 2025 ; ? (?): ?
