Comparative Efficacy and Safety of Sugammadex and Neostigmine
Status:
Recruiting
Trial end date:
2023-08-30
Target enrollment:
Participant gender:
Summary
Along with unconsciousness and analgesia, use a muscle relaxant (Neuromuscular blocking agent
NMBA) is now part of the classic triad of anesthesia. In surgery or interventional procedure
under general anesthesia, NMBA is needed to relax the muscles of the whole body. Its purpose
is to assist the placement of the endotracheal tube, avoid the participant's injury due to
involuntary movements, and also enables the surgeon to have a better surgical vision, etc.
Once the operation or procedure is completed, anesthesiologist will reverse the NMBA and
participants are recovered from general anesthesia. It is crucial to maintain hemodynamic
stability during this period. The participant's vital signs are unstable during this period
because the participant is gradually recovered from anesthesia and they feel throat
discomfort from endotracheal tube. Immediate extubation is encouraged in the operating
theatre and full recovery of neuromuscular function must be achieved prior to extubation of
the endotrachea tube.
Traditionally, acetylcholinesterase inhibitor (AChEI, such as neostigmine, pyridostigmine,
edrophonium) is used to reverse the efficacy of NMBA and stabilize the participants's vital
signs. However, the reversal of acetylcholine ester inhibitors is slow, the curative effect
has a ceiling effect, and the need to use anticholinergics (anticholinergics) to reduce the
incidence of adverse reactions and other issues. In addition, traditional muscle relaxants
may also cause complications, such as postoperative residual curarization (PORC). PORC is
associated with weakness of upper airway muscles and increased risk of hypoventilation and
hypoxemia, as well as risk for aspiration and postoperative pulmonary complications.
Sugammadex is a new selective relaxant-binding agent that quickly and effectively reverses
the effects of steroidal NMBAs, especially rocuronium and vecuronium. Compared with
neostigmine, sugammadex more substantially reduces PORC, but its effects on postoperative
complications require further investigation. Therefore, this study aimed to compare the
effects of sugammadex and neostigmine during emergence and extubation after general
anesthesia in non-cardiac surgery and interventional procedure.