title: Introduction of sugammadex as standard reversal agent: Impact on the incidence of residual neuromuscular blockade and postoperative patient outcome.
abstract: BACKGROUND
  The aim of this prospective audit was to investigate clinical practice related to muscle relaxant reversal and the impact made by the recent introduction of sugammadex on patient outcome at a tertiary teaching hospital.
  
  
  METHODS
  Data from all patients intubated at our institution during two epochs of seven consecutive days each was collected prospectively. Directly prior to extubation, the train-of-four (TOF) ratio was assessed quantitatively by an independent observer. Postoperative outcome parameters were complications in the recovery room and radiological diagnosed atelectasis or pneumonia within 30 days.
  
  
  RESULTS
  Data from 146 patients were analysed. Three reversal strategies were used: no reversal, neostigmine or sugammadex. The TOF ratio was less than 0.7 in 17 patients (nine no reversal, eight neostigmine) and less than 0.9 in 47 patients (24 no reversal, 19 neostigmine, four sugammadex). Those reversed with sugammadex showed fewer episodes of postoperative oxygen desaturation (15% vs. 33%; P<0.05). TOF ratios of less than 0.7 (P<0.05) and also <0.9 (P<0.01) were more likely associated with X-ray results consistent with postoperative atelectasis or pneumonia.
  
  
  CONCLUSIONS
  Our results suggest a significant impact of residual paralysis on patient outcome. The use of sugammadex resulted in the lowest incidence of residual paralysis.
authors.affiliation: Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth WA, Australia ; School of Medicine and Pharmacology, the University of Western Australia, Perth WA, Australia.
authors.forename: Thomas
authors.initials: T
authors.lastname: Ledowski
authors.forename: Samuel
authors.initials: S
authors.lastname: Hillyard
authors.forename: Brendan
authors.initials: B
authors.lastname: O'Dea
authors.forename: Rob
authors.initials: R
authors.lastname: Archer
authors.forename: Filipe
authors.initials: F
authors.lastname: Vilas-Boas
authors.forename: Barney
authors.initials: B
authors.lastname: Kyle
keywords: Neostigmine; residual paralysis; sugammadex