Anest. intenziv. Med. 2013;24(4):230-236

Anaesthesia for irreversible electroporation (IRE) prostatectomy: Reversal of neuromuscular blockade with sugammadex vs neostigmin. Retrospective studyAnaesthesiology - Original Paper

Herold Ivan^1,*, Sittová Naděžda¹, Čurdová Marcela¹, Kolombo Ivan², Pabišta Richard³, Adamus Milan⁴

¹ Anesteziologicko-resuscitační oddělení, Oblastní nemocnice Mladá Boleslav, a. s.

² Centrum robotické chirurgie a urologie, Nemocnice Na Homolce, Praha

³ Urologické oddělení, Oblastní nemocnice Mladá Boleslav, a. s.

⁴ Klinika anesteziologie, resuscitace a intenzivní medicíny, FN a LF UP v Olomouci

Objective:
Assessment of factors influencing the reversal of neuromuscular blockade with sugammadex (S) and neostigmin (N) in IRE prostatectomy requiring deep neuromuscular block until the end of surgery.


Type:
Retrospective study, analysis of anaesthesia charts.


Setting:
Department of Urology, Department of Anaesthe-siology and Intensive Therapy.

Materials and methods:
During a 5-month period (November 2011-March 2012) IRE prostatectomy were performed in 35 men in balanced general anaesthesia with rocuronium. At the end of surgery, S 200 mg (BRIDION) or N (NEOSTIGMIN) were administered for the reversal of deep block (TOF-count 0, PTC ≥ 5) or moderate block (TOF-count ≥ 1) respectively. We analysed the relation of the reversal to the rocuronium admini-stration: the intubation dose, total dose (absolute, per kg of body weight, number of supplementing boluses), duration of anaesthesia and ASA using non-parametric Mann Whitney and Fischer exact tests. Results are presented as mean values.

Results:
Sugammadex 200 mg (2.21 mg/kg) was administered in 22 (63%) patients with deep block (BRIDION group), neostigmin (0.027 mg/kg) in 13 (37%) patients with moderate block (NEOSTIGMIN group). Comparing to NEOSTIGMIN, higher doses of rocuronium - absolute dose (82.5 vs 65 mg, p = 0.001) and dose/kg bw (0.85 vs 0.69 mg/kg, p = 0.018) were given, the number of rocuronium boluses was higher (p = 0.013) and the anaesthesia was longer (100 vs 90 min, p = 0.044) in the BRIDION group. A dose of S 200 mg was sufficient in 20 patients (91 %) for block reversal. In 2 patients with a lower sugammadex dose (< 1.6 mg/kg), a supplement dose of 100 mg was required for complete block recovery after 3.5 min.

Conclusion:
In IRE prostatectomy, rocuronium-sugammadex combination appears to be a cost-effective strategy. A standard dose of 200 mg sugammadex at the end of surgery might be insufficient in obese patients (in doses < 1.6 mg/kg).

Keywords: neuromuscular blockade; akcelerometry; reversal; neostigmin; sugammadex; prostatectomy; irreversible electroporation

Received: April 20, 2013; Accepted: May 5, 2013; Published: August 1, 2013  Show citation