SUGAMMADEX ALWAYS FAST? PROBABLY YES, BUT IN LIVER TRANSPLANTATION

Background: Rapid neuromuscular block reversal at the end of major abdominal surgery is recommended to avoid postoperative residual. To date, no study has evaluated sugammadex use and performance after rocuronium administration in patients undergoing liver transplantation. This is a randomized controlled trial with the primary objective of assessing the recovery time of neuromuscular transmission with sugammadex versus neostigmine after rocuronium administration in patients undergoing LTx. Methods The TOF-Watch SX® with calibration and linked to a portable computer with TOF-Watch SX Monitor Software® was used to monitor and record intraoperative neuromuscular block, maintained with a continuous infusion of rocuronium. Anaesthetic management was standardized as per our institution's internal protocol. At the end of surgery, neuromuscular moderate block reversal was obtained after administration of 2 mg/kg of sugammadex or 50 mcg/kg of neostigmine (plus 10 mcg/kg of atropine). Results: Data from 41 patients undergoing liver transplantation were analysed. In this population, neuromuscular block recovery time was faster after administration of sugammadex than neostigmine, with a mean value±SD of 9.4±4.6 min vs. 34.6±24.9 min respectively (p<0.0001).Conclusion: neuromuscular block reversal after rocuronium continuous infusion was significantly faster with sugammadex than neostigmine and feasible in patients undergoing liver transplantation. It is important to note that sugammadex recovery time in this population was found to be considerably longer than in other surgical settings, an interesting finding that needs further studies to be fully explained and it should be taken into consideration in clinical practice.Trial registration: ClinicalTrials.gov NCT02697929.Keywords: rocuronium, neostigmine, reversal, recovery time, liver transplantation.

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