title: Sugammadex allows fast-track bariatric surgery.
abstract: BACKGROUND
  Morbidly obese (MO) patients are at increased risk for postoperative anesthesia-related complications. We evaluated the role of sugammadex versus neostigmine in the quality of recovery from profound rocuronium-induced neuromuscular blockade (NMB) in patients with morbid obesity.
  
  
  METHODS
  We studied 40 female MO patients who received desflurane and remifentanil anesthesia for laparoscopic removal of adjustable gastric banding. NMB was achieved with rocuronium. At the end of the surgical procedure, complete reversal of NMB was obtained with sugammadex (SUG group, n = 20) or neostigmine plus atropine (NEO group, n = 20) in the presence of profound NMB.
  
  
  RESULTS
  No difference in surgical time or anesthetic drugs was found between the groups. Anesthesia time was significantly greater in the NEO group than in the SUG group (95 ± 21 vs. 47.9 ± 6.4 min, p < 0.0001), which was mainly due to a longer time to reach a train-of-four ratio (TOFR) ≥ 0.9 in the NEO group (48.6 ± 18 vs. 3.1 ± 1.3 min, p < 0.0001) during reversal of profound NMB. Upon admission to the postanesthesia care unit, level of SpO2 (p = 0.018), TOFR (p < 0.0001), ability to swallow (p = 0.0027), and ability to get into bed independently (p = 0.022) were better in the SUG group than in the NEO group. Patients in the SUG group were discharged to the surgical ward earlier than patients in the NEO group were (p = 0.013).
  
  
  CONCLUSIONS
  Sugammadex allowed a safer and faster recovery from profound rocuronium-induced NMB than neostigmine did in patients with MO. Sugammadex may play an important role in fast-track bariatric anesthesia.
authors.affiliation: Department of Medicine, Anesthesiology and Intensive Care, University of Padova, Via C. Battisti, 267-35121, Padua, Italy, micarron@libero.it.
authors.forename: Michele
authors.initials: M
authors.lastname: Carron
authors.forename: Stefano
authors.initials: S
authors.lastname: Veronese
authors.forename: Mirto
authors.initials: M
authors.lastname: Foletto
authors.forename: Carlo
authors.initials: C
authors.lastname: Ori
mesh_terms: D000328:Adult; D000762:Anesthesia Recovery Period; D050110:Bariatric Surgery / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009388:Neostigmine / Q000627:therapeutic use*; D019148:Neuromuscular Blockade / Q000379:methods; D009469:Neuromuscular Junction / Q000187:drug effects* / Q000503:physiopathology; D009767:Obesity, Morbid / Q000503:physiopathology / Q000601:surgery*; D010277:Parasympathomimetics / Q000627:therapeutic use*; D000077122:Sugammadex; D016896:Treatment Outcome; D047408:gamma-Cyclodextrins / Q000627:therapeutic use*
chemical_list: D010277:Parasympathomimetics; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D009388:Neostigmine