title: Sugammadex facilitates early recovery after surgery even in the absence of neuromuscular monitoring in patients undergoing laryngeal microsurgery: a single-center retrospective study.
abstract: In many countries, routine clinical anaesthesia does not always involve neuromuscular monitoring. In these clinical settings, the efficacy and safety of sugammadex use has not yet been confirmed. We investigated the efficacy and safety of sugammadex in the absence of neuromuscular monitoring.
  
  
  
  One hundred and forty patients who underwent laryngeal microsurgery with the use of rocuronium as a neuromuscular blocking agent, without the use of a neuromuscular monitoring device, were retrospectively investigated. The patients were randomly chosen among all the patients who met the inclusion criteria at a tertiary university hospital between July 2013 and February 2015 and were allocated to group S (sugammadex group) or group P (pyridostigmine group) according to the neuromuscular reversal agent administered. Five patients were excluded from analysis and 135 patients completed the study. Primary outcome was extubation time. Secondary outcomes were anaesthesia time, the correlation between anaesthesia time and extubation time, the total amount of rocuronium, and postoperative adverse events in the post-anaesthesia care unit (PACU).
  
  
  
  Extubation time was significantly shorter in group S (6.3 ± 3.9 min) than in group P (9.0 ± 5.4 min). Anaesthesia time was also significantly shorter in group S (30.7 ± 10.3 min) than in group P (35.8 ± 12.6 min). In the patients with an anaesthesia time of 30 min or less, there was a positive correlation between anaesthesia time and extubation time in group P (r = 0.453), but there was no significant relationship in group S. The total amount of rocuronium used was higher in group S (0.62 ± 0.11 mg kg(-1)) than in group P (0.38 ± 0.14 mg kg(-1)). Postoperative adverse events in the PACU were comparable between the groups, except for tachycardia events: the incidence of tachycardia was significantly lower in group S (8.0 %) than in group P (17.3 %).
  
  
  
  Sugammadex could shorten anaesthesia and extubation times as well as recovery time in the PACU and reduce postoperative hemodynamic complications in a clinical setting in the absence of neuromuscular monitoring. This may enhance the patients' recovery in the operating room and PACU while improving the postoperative condition of patients.
  
  
  
  The trial was registered in the UMIN clinical trials registry ( www.umin.ac.jp/ctr/index/htm ; unique trial number: UMIN000016602; registration number: R000019266 ; principal investigator's name: Byung Gun Lim; date of registration: February 22, 2015).
authors.affiliation: Department of Anaesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
authors.forename: Eui-Seok
authors.initials: ES
authors.lastname: Park
authors.affiliation: Department of Anaesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea. bglim9205@korea.ac.kr.
authors.forename: Byung Gun
authors.initials: BG
authors.lastname: Lim
authors.affiliation: Department of Anaesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
authors.forename: Won-Joon
authors.initials: WJ
authors.lastname: Lee
authors.affiliation: Department of Anaesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
authors.forename: Il Ok
authors.initials: IO
authors.lastname: Lee
mesh_terms: D000328:Adult; D060666:Airway Extubation; D000732:Androstanols / Q000008:administration & dosage*; D000762:Anesthesia Recovery Period; D005260:Female; D006801:Humans; D007830:Larynx / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage; D011184:Postoperative Period; D012189:Retrospective Studies; D000077123:Rocuronium; D000077122:Sugammadex; D013997:Time Factors; D047408:gamma-Cyclodextrins / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology
chemical_list: D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D000077123:Rocuronium
keywords: Enhanced recovery after surgery (ERAS); Microsurgery; Neuromuscular blocking agents; Neuromuscular monitoring; Pyridostigmine bromide; Rocuronium; Sugammadex