Retrospective investigation of postoperative outcome after reversal of residual neuromuscular blockade Sugammadex, neostigmine or no reversal

BACKGROUND Postoperative residual neuromuscular blockade (RNMB) is associated with significant morbidity. OBJECTIVE The aim of this retrospective data analysis was to investigate the influence of the method of RNMB reversal on postoperative outcome. SETTING Tertiary teaching hospital in Western Australia. PATIENTS With Ethics Committee approval, data from 1444 patients who received at least one dose of a non-depolarising muscle relaxant intraoperatively during 2011 were analysed. MAIN OUTCOME MEASURES Endpoints included unwanted events in the postanaesthesia care unit (PACU); symptoms of pulmonary complications within 7 postoperative days (0 to 100 outcome score based on 'temperature >38 degrees C', 'leucocyte count >11 x 10(9) l(-1)', 'physical examination consistent with pneumonia' and 'shortness of breath'); PACU turnover time; and length of hospital stay. RESULTS Data from 1444 patients (722 sugammadex, 212 neostigmine and 510 no-reversal) were analysed. The incidence of postoperative nausea and vomiting (PONV) in PACU was higher in neostigmine-reversed than sugammadex-reversed patients (21.5 vs. 13.6%; P<0.05). No differences were found regarding other PACU incidents, length of PACU stay or hospital stay. Pulmonary outcome deteriorated significantly (outcome score increased) with age and American Society of Anesthesiologists (ASA) physical status. This was observed particularly in ASA 3/4 patients more than 60 years of age in neostigmine-reversed or non-reversed patients, but almost no detrimental effect of age on pulmonary outcome was found in the sugammadex group (P<0.05). CONCLUSION RNMB reversal with sugammadex was associated with the lowest rate of PONV and may reduce the risk of pulmonary complications in elderly ASA 3/4 patients.