title: Operating room discharge after deep neuromuscular block reversed with sugammadex compared with shallow block reversed with neostigmine: a randomized controlled trial.
abstract: OBJECTIVE
  To determine if reversing a deep or moderate block with sugammadex, compared with a shallow block reversed with neostigmine, reduces the time to operating room discharge after surgery and the time spent in the postanesthesia care unit.
  
  
  METHODS
  A randomized controlled trial.
  
  
  METHODS
  Monocentric study performed from February 2011 until May 2012.
  
  
  METHODS
  One hundred consenting women with American Society of Anesthesiologists grade I or II were randomized into 2 groups.
  
  
  METHODS
  Laparoscopic hysterectomy was performed under desflurane general anesthesia. For the neostigmine (N) group, 0.45 mg · kg-1rocuronium was followed by spontaneous recovery. A 5-mg rescue bolus was administered only if surgical evaluation was unacceptable. At the end of surgery, 50 μg · kg-1neostigmine with glycopyrrolate was administered. For the sugammadex (S) group, a higher intubating rocuronium dose (0.6 mg · kg-1) was followed by 5-mg boluses each time the train-of-four count exceeded 2. Sugammadex (2-4 mg · kg-1) was administered to reverse the block. All patients were extubated after obtaining a train-of-four ratio of 0.9.
  
  
  METHODS
  The duration between the end of surgery and operating room discharge and the time spent in the postanesthesia care unit.
  
  
  RESULTS
  The time till operating room discharge was shorter and more predictable in group S (9.15±4.28 minutes vs 13.87±11.43 minutes in group N; P=.005). The maximal duration in group S was 22 minutes, compared with 72 minutes in group N. The time spent in the postanesthesia care unit was not significantly different (group S: 47.75±31.77 minutes and group N: 53.43±40.57 minutes; P=.543).
  
  
  CONCLUSIONS
  Maintaining a deep neuromuscular block during laparoscopic hysterectomy reversed at the end of the procedure with sugammadex enabled a faster and more predictable time till operating room discharge than did the classical combination of a shallower block reversed with neostigmine.
authors.affiliation: Anesthesiology Department, Université Catholique de Louvain, CHU UCL Namur, 1, Avenue Gaston Thérasse, B-5530 Yvoir, Belgium. Electronic address: laurie.putz@uclouvain.be.
authors.forename: Laurie
authors.initials: L
authors.lastname: Putz
authors.affiliation: Anesthesiology Department, Université Catholique de Louvain, CHU UCL Namur, 1, Avenue Gaston Thérasse, B-5530 Yvoir, Belgium.
authors.forename: Christophe
authors.initials: C
authors.lastname: Dransart
authors.affiliation: Scientific Support Unit, Université Catholique de Louvain, CHU UCL Namur, 1, Avenue Gaston Thérasse, B-5530 Yvoir, Belgium.
authors.forename: Jacques
authors.initials: J
authors.lastname: Jamart
authors.affiliation: Gynecology Department, Université Catholique de Louvain, CHU UCL Namur, 1, Avenue Gaston Thérasse, B-5530 Yvoir, Belgium.
authors.forename: Maria-Laura
authors.initials: ML
authors.lastname: Marotta
authors.affiliation: Anesthesiology Department, Université Catholique de Louvain, CHU UCL Namur, 1, Avenue Gaston Thérasse, B-5530 Yvoir, Belgium.
authors.forename: Geraldine
authors.initials: G
authors.lastname: Delnooz
authors.affiliation: Anesthesiology Department, Université Catholique de Louvain, CHU UCL Namur, 1, Avenue Gaston Thérasse, B-5530 Yvoir, Belgium.
authors.forename: Philippe E
authors.initials: PE
authors.lastname: Dubois
mesh_terms: D000328:Adult; D000732:Androstanols / Q000008:administration & dosage / Q000009:adverse effects / Q000037:antagonists & inhibitors*; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D000077335:Desflurane; D005260:Female; D006024:Glycopyrrolate / Q000008:administration & dosage; D006801:Humans; D007044:Hysterectomy; D007530:Isoflurane / Q000008:administration & dosage / Q000031:analogs & derivatives; D010535:Laparoscopy; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000008:administration & dosage; D009388:Neostigmine / Q000008:administration & dosage*; D019148:Neuromuscular Blockade / Q000191:economics / Q000379:methods*; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000037:antagonists & inhibitors*; D009873:Operating Rooms / Q000191:economics; D061646:Operative Time; D010351:Patient Discharge / Q000191:economics; D000077123:Rocuronium; D000077122:Sugammadex; D013997:Time Factors; D047408:gamma-Cyclodextrins / Q000008:administration & dosage*
chemical_list: D000732:Androstanols; D018685:Anesthetics, Inhalation; D018727:Muscarinic Antagonists; D003473:Neuromuscular Nondepolarizing Agents; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D009388:Neostigmine; D000077335:Desflurane; D007530:Isoflurane; D006024:Glycopyrrolate; D000077123:Rocuronium
keywords: Neostigmine; Neuromuscular blockade; Recovery room; Rocuronium; Sugammadex