title: [Clinical evaluation of post-surgical bleeding after a sugammadex injection].
abstract: OBJECTIVE
  Sugammadex reverses neuromuscular blockade by chemical encapsulation of nondepolarizing neuromuscular blocking drugs (rocuronium and vecuronium). The imprint of this new molecule has recently been supplemented with a section on haemostasis notifying a longer clotting time without documented clinical consequences. This has resulted in recommendations on the use of sugammadex in the presence of coagulation disorders (pharmacologically-induced or not). The objective of this study was to analyze the experience gathered with this molecule on clinically-evaluated bleeding. No study on this subject is currently available.
  
  
  METHODS
  This is a retrospective study over 1 year between August 2009 and August 2010. All patients with laparotomies for cancer surgery requiring suction drains were included. Patients were allocated to groups according to the type of reversal (without sugammadex versus sugammadex 2 or 4 mg/kg). The endpoint was clinically-evaluated postoperative bleeding (reoperation for haemostasis, blood-stained laparotomy dressings in the post-anaesthesia care unit [PACU], cumulative volume collected in suction drains upon arrival in PACU and then after 2 hours and the next morning at 6a.m).
  
  
  RESULTS
  One hundred and ninety-three patients were included in three groups, 78 in the group "without sugammadex", 95 in "sugammadex 2mg/kg" and 20 in "sugammadex 4 mg/kg". There were no reoperations for haemostasis. The comparison among different groups for the endpoint of bleeding showed no significant difference.
  
  
  CONCLUSIONS
  In this retrospective study performed in patients at high risk of postoperative bleeding, sugammadex at doses of 2 and 4 mg/kg was not associated with increased bleeding. This study, the first in this field, suggests that future prospective investigations should target patients receiving 4 or 16 mg/kg of sugammadex and/or with documented preoperative abnormal coagulations tests.
authors: Département d'anesthésie-réanimation, Centre Alexis-Vautrin, Université de Nancy, avenue de Bourgogne, 54511 Vandœuvre-lès-Nancy, France.
authors: J
authors: J
authors: Raft
authors: J-F
authors: JF
authors: Betala Belinga
authors: G
authors: G
authors: Jurkolow
authors: E
authors: E
authors: Desandes
authors: D
authors: D
authors: Longrois
authors: C
authors: C
authors: Meistelman
mesh_terms: D000328:Adult; D000368:Aged; D000732:Androstanols / Q000037:antagonists & inhibitors; D003422:Critical Care; D004305:Dose-Response Relationship, Drug; D004322:Drainage; D023381:Endpoint Determination; D005260:Female; D006487:Hemostasis; D006801:Humans; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000601:surgery; D019148:Neuromuscular Blockade; D003473:Neuromuscular Nondepolarizing Agents / Q000037:antagonists & inhibitors; D019106:Postoperative Hemorrhage / Q000139:chemically induced* / Q000175:diagnosis; D012189:Retrospective Studies; D000077123:Rocuronium; D000077122:Sugammadex; D014673:Vecuronium Bromide / Q000009:adverse effects; D047408:gamma-Cyclodextrins / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D014673:Vecuronium Bromide; D000077123:Rocuronium