Effect of Sugammadex on the Recovery Profiles of Cardiac Patients Undergoing Non-Cardiac Surgery

Effect of Sugammadex on the Recovery Profiles of Cardiac Patients Undergoing Non-Cardiac Surgery

The global trend of an aging population and the increasing prevalence of coronary heart disease (CHD) have led to a rise in the number of non-cardiac surgeries performed on patients with CHD. These patients are particularly vulnerable to drastic fluctuations in hemodynamic parameters, which can be life-threatening due to their limited tolerance for increased cardiac load and decreased oxygen delivery. Residual paralysis from neuromuscular blockade (NMB) after general anesthesia can exacerbate these risks by causing respiratory muscle weakness and hypoxemia, further straining the patient’s cardiovascular system.

Traditionally, the cholinesterase inhibitor neostigmine has been used to reverse NMB after surgeries under general anesthesia. However, its use in CHD patients is problematic due to potential side effects such as myocardial ischemia, cardiac arrhythmia, and atrioventricular block, especially when combined with atropine. Sugammadex, a newer NMB reversal agent, offers a selective mechanism for reversing steroidal muscle relaxants like rocuronium. Despite its advantages, the specific effects of sugammadex on the recovery profiles of CHD patients undergoing non-cardiac surgery have not been thoroughly investigated.

This retrospective observational study aimed to evaluate the impact of sugammadex on the recovery profiles of CHD patients undergoing non-cardiac surgery. The study was conducted at the First Affiliated Hospital of Nanjing Medical University and included 200 CHD patients who had undergone percutaneous coronary intervention at least three months prior to surgery. Patients with neuromuscular diseases or other organ dysfunctions were excluded to ensure a focused analysis on the cardiovascular implications of sugammadex use.

The patients were divided into two groups: 100 patients who received sugammadex (group S) and 100 patients who did not receive any NMB reversal (group N). The groups were matched by surgery type to ensure comparability. In group S, a dose of approximately 200 mg of sugammadex was administered when the Train-of-Four Stimulation (TOF) count reached ≥2 after surgery. The tracheal tube was removed when the TOF ratio exceeded 0.9. In contrast, group N patients did not receive any NMB reversal agents.

The study’s findings revealed significant differences in recovery profiles between the two groups. The average time to remove the endotracheal tube was markedly shorter in group S (2.3 ± 1.1 minutes) compared to group N (32.4 ± 11.5 minutes). This rapid reversal of NMB by sugammadex facilitated quicker extubation, reducing the duration of mechanical ventilation and its associated risks.

Hemodynamic stability was another critical area of comparison. In group S, systolic blood pressure (BP) remained stable before and after extubation, with no significant differences observed at 0, 5, and 10 minutes post-extubation. In contrast, group N exhibited a sharp increase in systolic BP immediately after extubation, with a rise of 17 mmHg compared to baseline (150 ± 24 mmHg vs. 133 ± 18 mmHg). This increase persisted at 5 and 10 minutes post-extubation, with systolic BP consistently exceeding 150 mmHg. Similar trends were observed for diastolic BP and mean BP, which also showed significant increases in group N after extubation. Additionally, heart rate in group N increased significantly at 0, 5, and 10 minutes post-extubation, indicating heightened cardiovascular stress.

The study also evaluated post-anesthesia care unit (PACU) stay time and the incidence of post-operative complications. Group S demonstrated a significantly shorter PACU stay time (43.5 ± 18.2 minutes) compared to group N (74.8 ± 21.2 minutes). Furthermore, the incidence of hypoxemia was lower in group S (7%) than in group N (24%), and the occurrence of arrhythmias was also reduced in group S (3%) compared to group N (12%). These findings underscore the benefits of sugammadex in minimizing post-operative complications and enhancing recovery efficiency.

The hemodynamic stability observed in group S is particularly noteworthy, as previous research has shown that increases in systolic BP by more than 20 mmHg or diastolic BP by more than 10 mmHg are associated with a two-fold increase in the risk of cardiovascular complications. By attenuating these fluctuations, sugammadex not only facilitates a smoother recovery but also reduces the likelihood of adverse cardiovascular events.

In conclusion, this study highlights the advantages of sugammadex in the management of CHD patients undergoing non-cardiac surgery. Its rapid and effective reversal of NMB leads to quicker extubation, improved hemodynamic stability, and a reduction in post-operative complications. These benefits make sugammadex a valuable alternative to traditional NMB reversal agents like neostigmine, particularly in high-risk populations such as CHD patients. The findings suggest that incorporating sugammadex into the perioperative care of CHD patients can enhance recovery profiles and improve overall surgical outcomes.

doi.org/10.1097/CM9.0000000000001599

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