Neuromuscular blockade management and postoperative outcomes in enhanced recovery colorectal surgery: secondary analysis of POWER trial

Serrano, A.B. ; Díaz-Cambronero, O. ; Melchor-Ripollés, J. ; Abad-Gurumeta, A. ; Ramírez-Rodríguez, J.M. (Universidad de Zaragoza) ; Martínez-Ubieto, J. (Universidad de Zaragoza) ; Sánchez-Merchante, M. ; Rodríguez, R. ; Jordá, L. ; Gil-Trujillo, S. ; Cabellos-Olivares, M. ; Bordonaba-Bosque, D. (Universidad de Zaragoza) ; Aldecoa, C.

Resumen: BACKGROUND: We evaluated the impact of neuromuscular blockade (NMB) management, monitoring and reversal on postoperative outcomes in colorectal surgical patients included in an enhanced recovery program.
METHODS: We performed a predefined analysis in 2084 patients undergoing elective colorectal surgery who participated in POWER study. We analyzed them for complications, length of hospital stay and mortality. Two groups were defined: 1) monitoring + reversal of the neuromuscular blockade (M+R) group: all patients receiving neuromuscular blockade monitoring plus reversal of it with any drug (neostigmine or sugammadex) were included; and 2) no monitoring nor reversal (noM+noR) group. In this group all the patients who did not receive monitoring and reversal of the neuromuscular blockade were allocated.
RESULTS: Multivariate analysis found no statistically significant differences in moderate-severe complications (174 [25.7%] vs. 124 [27.1%]; P=0.607), length of hospital stay (10.8±11.1 vs. 11.0 ±12.6 days; P=0.683) and mortality (6 [0.9%] vs. 5 [1.1%]; P=0.840) between the group receiving optimal neuromuscular management (M+R) and the one did not receive it (noM+noR). Univariate analysis showed patients reversed with neostigmine died more than those reversed with sugammadex (3 [2.7%] vs. 3 [0.5%]; P=0.048).
CONCLUSIONS: Our data suggest optimal neuromuscular blockade management in colorectal surgery is not associated with less moderate-severe complications, length of hospital stay or death during postoperative period in an enhanced recovery program. Neostigmine reversal seems to be linked to higher rate of mortality than sugammadex.

Idioma: Inglés

DOI: 10.23736/S0375-9393.20.14589-9

Año: 2021

Publicado en: Minerva Anestesiologica 87, 1 (2021), 13-25
ISSN: 0375-9393

Factor impacto JCR: 3.396 (2021)

Categ. JCR: CRITICAL CARE MEDICINE rank: 20 / 35 = 0.571 (2021) - Q3 - T2
Categ. JCR: ANESTHESIOLOGY rank: 18 / 34 = 0.529 (2021) - Q3 - T2

Factor impacto CITESCORE: 4.2 - Medicine (Q2)

Factor impacto SCIMAGO: 0.539 - Anesthesiology and Pain Medicine (Q2)

Tipo y forma: Artículo (Versión definitiva)

Área (Departamento): Área Cirugía (Dpto. Cirugía)
Área (Departamento): Área Métodos Cuant.Econ.Empres (Dpto. Economía Aplicada)