P034: DOES SUGAMMADEX REDUCE CRITICAL RESPIRATORY EVENTS IN MORBIDLY OBESE PATIENTS AFTER BARIATRIC SURGERY: A COMPARISON OF 2 CONSECUTIVE COHORTS
Patrick Ziemann-Gimmel, Matt Barros, Allison Goldfarb, Meghan Connelly; Sheridan Healthcare
Background: Bariatric patients are at high risk for postoperative respiratory events. Postoperative residual neuromuscular blockade (PRNB) defined as a Train-of-four ratio of less than 0.9 seems to increase the risk of critical respiratory events. Sugammadex is a newly FDA approved drug to reverse rocuronium. The hypothesis is that the use of sugammadex may reduce the incidence of PRNB and CREs in PACU. The purpose of the study was to compare two consecutive cohorts of morbidly obese patients after bariatric surgery – one reversed with neostigmine and the other with sugammadex.
Methods: After IRB approval data from a prospective RCT (neostigmine – Ns group – n=317) was compared to observational data from 51 patients (sugammadex – Su group). Routine statistical methods included methods to compare distribution, mean and median. A hierarchical model was employed using the Holme’s correction for multiple comparisons. The power analysis indicated that to determine a difference between proportionNs=0.13 and proportionSu=0.32 in 2 independent groups a sample size of 50 patients in the Ns group is necessary (Ns n=50, Su n=294, alpha 0.05 and power 0.8).
Results: Both groups had comparable baseline characteristics: Age, gender, risk score, surgical procedure and procedural times. There was no difference in pain or PONV scores, morphine equivalent dose or the number of patients requiring antiemetic rescue medication. More patients in the Su had a CRE compared to the Ns group (p<0.001). More patients in the Su group required verbal stimulation (p<0.001). Approximately 56.8% of patients required verbal stimulation in the Su group compared to 22.2% in the Ns group. After the next highest CRE (tactile stimulation) tested not significant, no further comparison was done.
Discussion: The introduction of sugammadex did not “automatically” reduce CREs in the PACU. The results indicate that patients required more verbal stimulation in the Su group increasing the number of patients developing a CRE. One possible reason is the underreporting of “verbal” stimulation in the Ns group (22.2%). It is a very low incidence of verbal stimulation in postsurgical patients. The large study (Ns group) collected data over a 2 year time period and there were staff changes in the PACU that could have affected documentation of CREs.