The relationship between the sugammadex use and postoperative reintubation in the absence of neuromuscular monitoring

Abstract

Background: Evidences show that sugammadex may facilate extubation after surgery. Applying neuromuscular monitoring in general anesthesia may prevent postoperatrive reintubation. However, routine general anesthesia does not always include neuromuscular monitoring. Therefore, we investigated the relationship between the sugammadex use and postoperative reintubation in the absence of neuromuscular monitoring. Methods: We conducted a retrospective analysis of the incidence of postoperative reintubation in the operating room (OR) or postanesthesia care unit following sugammadex use in the absence of neuromuscular monitoring that involved a large number of patients over 4 years (from January 2017 to August 2020). Postoperative reintubation was applied for patients who had peripheric oxygen saturation <90% despite being given 6 L/min oxygen with a face mask. Patients with perioperative neuromuscular monitoring, renal or hepatic failure, electrolyte imbalance, body mass index over 35, incomplete data, and age under 20 years were excluded. All data from the ORs' database and anesthesia records were analyzed. Results: Of 6582 patients receiving sugammadex, 6313 were included in this study. Two confirmed cases of postoperative reintubation were detected, with an incidence of 0.03% (2 of 6,313). As of the type of surgery, a 34 years old male received elective thoracic surgery, and another 66 years old male received elective urological surgery. No long-term pulmonary sequelae were found. Conclusion: This study suggests that the occurrence of postoperative reintubation following sugammadex (2–4 mg/kg) use is rare even in the absence of neuromuscular monitoring. Further large prospective studies are required to validate the findings of this study.

Keywords

• sugammadex
• general anesthesia
• reintubation
• neuromuscular monitoring
• postoperative residual curarization