Retrospective Comparison of Age-Related Efficacy and Cost of Sugammadex and Neostigmine in Obese Female Patients Undergoing Elective Surgery

Yıl 2024, Cilt: 8 Sayı: 3, 175 - 180, 30.12.2024

Miraç Alasu , Filiz Alkaya Solmaz

https://doi.org/10.30565/medalanya.1514454

Öz

Aim: The purpose of the study is to compare the clinical impact and cost of sugammadex and neostigmine in obese, young-elderly patients.

Materials and Methods: In this study, the medical and anesthesia records of patients whose operation did not exceed 150 minutes and who used rocuronium as a muscle relaxant were evaluated retrospectively. Patients whose files were examined were divided into 4 groups according to age and drug given; Group YS: 2 mg/kg sugammadex between 20–60 years, Group ES: 2 mg/kg sugammadex between 60-80years, Group YN: 0.04 mg/kg neostigmin + 0.01 mg/kg atropine between 20–60 years, Group EN: 0.04 mg/kg neostigmin + 0.01 mg/kg atropine between 60–80 years. Time of TOF 25, 75, 90 recovery scores were recorded from the anesthesia records of the patients.

Results: Regarding the time to reach TOF 25,75,90, it was seen that the patients in Group YS and Group ES reached faster TOF values than Group YN and Group EN ( p<0,05). Compared with neostigmine, patients who were given sugammadex in the same age group were found to have faster recovery time and statistically significant differences (p<0,05).

Conclusion: Sugammadex provides rapid and effective reversal of moderate neuromuscular block compared to neostigmine, with a very low incidence of side effects and faster recovery times.

Anahtar Kelimeler

Neostigmine, Obesity, Sugammadex, Tof, Age

Elektif Cerrahi Uygulanan Obez Kadın Hastalarda Sugammadeks ve Neostigminin Yaşa Bağlı Etkinlik ve Maliyetinin Retrospektif Olarak Karşılaştırılması

Öz

Amaç: Çalışmanın amacı, obez, genç-yaşlı hastalarda sugammadeks ve neostigminin klinik etkisini ve maliyetini karşılaştırmaktır.

Gereç ve Yöntemler: Bu çalışmada, ameliyat süresi 150 dakikayı geçmeyen ve kas gevşetici olarak rokuronyum kullanılan hastaların tıbbi ve anestezi kayıtları retrospektif olarak değerlendirildi. Dosyaları incelenen hastalar yaş ve verilen ilaca göre 4 gruba ayrıldı; Grup YS: 20-60 yaş arası 2mg/kg sugammadeks, Grup ES: 60-80 yaş arası 2mg/kg sugammadeks, Grup YN: 20-60 yaş arası 0,04 mg/kg neostigmin + 0,01 mg/kg atropin, Grup EN: 60-80 yaş arası 0,04 mg/kg neostigmin + 0,01 mg/kg atropin. TOF 25,75,90 zamanı, derlenme skorları hastaların anestezi kayıtlarından kaydedildi.

Bulgular: TOF 25,75,90'a ulaşma süreleri açısından Grup YS ve Grup ES'deki hastaların Grup YN ve Grup EN'ye göre daha hızlı TOF değerlerine ulaştığı görüldü. (p<0,05). Neostigmin ile karşılaştırıldığında, aynı yaş grubunda sugammadeks verilen hastaların daha hızlı iyileşme süresine sahip olduğu ve istatistiksel olarak anlamlı farklılıklar olduğu bulundu (p<0,05).

Sonuç: Sugammadeks, neostigmine göre orta dereceli nöromüsküler bloğun hızlı ve etkili geri dönüşümünü sağlamakla birlikte, çok düşük yan etki insidansına ve daha hızlı iyileşme sürelerine sahiptir.

Anahtar Kelimeler

Neostigmin, Obezite, Sugammadeks, TOF, Yaş

Kaynakça

• 1. Baillard C, Clec’h C, Catineau J, Salhi F, Gehan G, Cupa M, et al. Postoperative residual neuromuscular block: A survey of management. Br J Anaesth. 2005;95(5):622-6. doi: 10.1093/bja/aei240
• 2. Aniskevich S, Leone BC Brull SC Sugammadex: a novel approach to reversal of neuromuscular blockade Expert Rev Neurother. 2011;11(2):185-98. doi: 10.1586/ern.11.2.
• 3. Sabuncu Ü, Kuşderci SH, Öterkuş M, Abdullayev R, Uludağ Ö, Özdaş S. Comparison the effects of sugammadex and neostigmine/atropine on cognitive functions in bariatric surgery patents: Randomized controlled trial: The effects of sugammadex on cognitive functions in bariatric surgery. J Surg Med. 2023;7(6),383–6. doi: 10.28982/josam.7605.
• 4. Loftsson T, Duchene D. Cyclodextrins and their pharmaceutical applications. Int J Pharm. 2007; 329(1-2): 1-11. doi: 10.1016/j.ijpharm.2006.10.044.
• 5. Gijsenbergh F, Ramael S, Houwing N, Van Lersel T. First human exposure of Org 25969, a novel agent to reverse the action of rocuronium bromide. The Journal of the American Society of Anesthesiologists 2005; 103(4): 695-703. doi: 10.1097/00000542-200510000-00007.
• 6. Fujinaga A, Fukushima Y, Kojima A, Sai Y, Ohashi Y, Kuzukawa A, et al. Anesthetic management of an extremely obese patient. J Anesth. 2007;21(2): 261-4. doi: 10.1007/s00540-006-0484-8.
• 7. Suzuki T, Masaki G, Ogawa S. Neostigmine-induced reversal of vecuronium in normal weight, overweight and obese female patients. Br J Anesth. 2006;97(2):160-3. doi: 10.1093/bja/ael142.
• 8. Baquero GA, Rich MW. Perioperative care in older adults. J Geriatr Cardiol. 2015;12(5):465-9. doi: 10.11909/j.issn.1671-5411.2015.05.018.
• 9. Waheed Z, Amatul-Hadi F, Kooner A, Afzal M, Ahmed R, Pande H, et al. General Anesthetic Care of Obese Patients Undergoing Surgery: A Review of Current Anesthetic Considerations and Recent Advances. Cureus. 2023;15(7):e41565. doi: 10.7759/cureus.41565.
• 10. Blobner M, Eriksson LI, Scholz J, Motsch J, Della Rocca G, Prins ME. Reversal of rocuronium-induced neuromuscular blockade with sugammadex compared with neostigmine during sevoflurane anaesthesia: Results of a randomised, controlled trial. Eur J Anaesthesiol. 2010;27(10):874-81. doi: 10.1097/EJA.0b013e32833d56b7.
• 11. Keating GM. Sugammadex: A Review of Neuromuscular Blockade Reversal. Drugs 2016;76(10):1041–52. doi: 10.1007/s40265-016-0604-1.
• 12. Caldwell JE, Miller RD. Clinical implications of sugammadex. Anaesthesia 2009;64 Suppl 1:66-72. doi: 10.1111/j.1365-2044.2008.05872.x.
• 13. Sorgenfrei IF, Norrild K, Larsen PB, Stensballe J, Østergaard D, Prins ME, et al. Reversal of rocuronium-induced neuromuscular block by the selective relaxant binding agent sugammadex: A dose-finding and safety study. Anesthesiology. 2006; 104(4):667-74. doi: 10.1097/00000542-200604000-00009.
• 14. Choi ES, Oh AY, Seo KS, Hwang JW, Ryu JH, Koo BW, et al. Optimum dose of neostigmine to reverse shallow neuromuscular blockade with rocuronium and cisatracurium. Anaesthesia 2016;71(4):443-9. doi: 10.1111/anae.13398.
• 15. Van Lancker P, Dillemans B, Bogaert T, Mulier JP, De Kock M, Haspeslagh M. Ideal versus corrected body weight for dosage of sugammadex in morbidly obese patients. Anaesthesia 2011;66(8):721-5. doi: 10.1111/j.1365-2044.2011.06782.x.
• 16. Woo T, Kim KS, Shim YH, Kim MK, Yoon SM, Lim YJ, et al. Sugammadex versus neostigmine reversal of moderate rocuronium-induced neuromuscular blockade in Korean patients. Korean J Anesthesiol. 2013;65(6):501-507. doi: 10.4097/kjae.2013.65.6.501.
• 17. Chambers D, Paulden M, Paton F, Heirs M, Duffy S, Craig D, et al. Sugammadex for the reversal of muscle relaxation in general anaesthesia: A systematic review and economic assessment. Health Technol Assess. 2010;14(39):1-211. doi: /10.3310/hta14390.
• 18. Ünal DY, Baran İ, Mutlu M, Ural G, Akkaya T, Özlü O. Comparison of sugammadex versus neostigmine costs and respiratory complications in patients with obstructive sleep apnea Turk J Anaesthesiol Reanim. 2015,43(6),387-95. doi: 10.5152/TJAR.2015.35682.
• 19. Yörükoğlu D, Alkaya Solmaz F. Kas Gevşeticiler. Anestezi, Yoğun Bakım, Ağrı. 1. Baskı (Editör Tüzüner F.) Nobel Tıp Kitabevleri, Ankara, 2010, 239-256.
• 20. Lemmens HJ, El-Orbany MI, Berry J, Morte JB, Martin G. Reversal of profound vecuronium-induced neuromuscular block under sevoflurane anesthesia: Sugammadex versus neostigmine. BMC Anesthesiol. 2010;10(1):15. doi: 10.1186/1471-2253-10-15.
• 21. Castro Jr DS, Leão P, Borges S, Gomes L, Pacheco M, Figueiredo P. Sugammadex reduces postoperative pain after laparoscopic bariatric surgery: A randomized trial. Surg Laparos Endos Percutan Tech. 2014,24(5):420-3. doi: 10.1097/SLE.0000000000000049.
• 22. Ali HH. Criteria of adequate clinical recovery from neuromuscular block. Anesthesiology. 2003;98(5):1278-80. doi: 10.1097/00000542-200305000-00033.
• 23. Esteves S, Martins M, Barros F, Barros F, Canas M, Vitor P, et al. Incidence of postoperative residual neuromuscular blockade in the postanaesthesia care unit: An observational multicentre study in Portugal. Eur J Anaesthesiol. 2013,30(5),243-249. doi: 10.1097/EJA.0b013e32835dccd7.
• 24. Hayes AH, Mirakhur RK, Breslin DS, Reid JE, McCourt KC. Postoperative residual block after intermediate‐acting neuromuscular blocking drugs. Anaesthesia. 2001;56(4):312-8. doi: 10.1046/j.1365-2044.2001.01921.x.
• 25. Pişkin Ö, Küçükosman G, Altun DU, Çimencan M, Özen B, Aydın B et al. The effect of sugammadex on postoperative cognitive function and recovery. Braz J Anesthesiol. 2016;66(4),376-82. doi: 10.1016/j.bjane.2014.10.003.