Staggering the dose of sugammadex lowers risks for severe emergence cough: a randomized control trial

BMC Anesthesiol. 2017 Oct 11;17(1):137. doi: 10.1186/s12871-017-0430-3.

Abstract

Background: Cough on emergence has been reported as a common adverse reaction with sugammadex reversal. We investigated if staggering the dose of sugammadex will reduce emergence cough in a single-center, randomized, double-blinded study.

Methods: A hundred and twenty ASA 1-3 adults were randomly reversed with 1 mg/kg sugammadex prior to extubation followed by another 1 mg/kg immediately after extubation (staggered group), single dose of 2 mg/kg sugammadex (single bolus group) or neostigmine 0.02 mg/kg with glycopyrrolate (neostigmine group).

Results: We found 70% of patients (n = 28) reversed with single boluses of sugammadex had Grade 3 emergence cough compared to 12.5% (n = 5) in the staggered sugammadex group and 17.5% (n = 7) in the neostigmine group (p < 0.001). Besides cough, emergence agitation also appeared highest in the single bolus sugammadex group (n = 14, 35%, p = 0.005). On the other hand, staggering sugammadex lowered risks of developing severe cough (RR 0.2, p < 0.001) and agitation (RR 0.43, p = 0.010) on emergence in addition to cough (RR 0.25, p = 0.039) and early sore throat (RR 0.70, p = 0.036) in the post-anesthetic care unit. The risks for severe emergence cough (RR 0.86, p = 0.762), severe cough in the post-anesthetic care unit (RR 1.0, p = 1.000) and sore throat (RR 1.17, p = 0.502) were also not different between the staggered sugammadex group and control given neostigmine. In terms of timing, there was no delay in time taken from discontinuing anesthetic agents to reversal and extubation if sugammadex was staggered (emergence time 6.0 ± 3.2 s, p = 0.625 and reversal time 6.5 ± 3.5, p = 0.809).

Conclusions: Staggering the dose of sugammadex for reversal will effectively decrease common emergence and early postoperative complications.

Trial registration: ANZCTR Number ACTRN12616000116426 . Retrospectively registered on 2nd February 2016.

Keywords: Emergence agitation; Emergence cough; Reversal; Sore throat; Sugammadex.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Cough / diagnosis*
  • Cough / etiology
  • Cough / prevention & control*
  • Dose-Response Relationship, Drug
  • Double-Blind Method
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neuromuscular Blockade / adverse effects
  • Neuromuscular Blockade / methods
  • Postoperative Complications / diagnosis*
  • Postoperative Complications / etiology
  • Postoperative Complications / prevention & control*
  • Severity of Illness Index*
  • Sugammadex
  • gamma-Cyclodextrins / administration & dosage*
  • gamma-Cyclodextrins / adverse effects

Substances

  • gamma-Cyclodextrins
  • Sugammadex