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ORIGINAL ARTICLE
Year : 2016  |  Volume : 3  |  Issue : 2  |  Page : 80-85

Sugammadex and its effect on respiratory outcome in obstructive sleep apnea patients undergoing laproscopic bariatric surgery


Department of Anesthesia and Surgical Intensive Care, Alexandria University Hospital, Alexandria, Egypt

Correspondence Address:
Mohamed S Elhadidi
Department of Anesthesia and Surgical Intensive Care, Alexandria University Hospital, Alexandria, 21648
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2356-9115.189789

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Background Obesity has clearly emerged as a worldwide epidemic, and because obesity is a well-recognized risk factor for the development of obstructive sleep apnea (OSA), physicians will undoubtedly encounter patients with OSA undergoing surgery. The increased incidence of postoperative respiratory problems in patients with OSA could be explained by the depressive effects of narcotics as well as other anesthetic drugs on the function of the upper airway muscles. Anesthesia may also attenuate the ventilatory response to airway obstruction and abolish normal response to hypoxia and hypercapnia. Aim The aim of this work was to evaluate sugammadex and its effect on the respiratory outcome in OSA patients undergoing laparoscopic bariatric surgery. Patients and methods Patients were included in the study after obtaining informed written consent (IRB NO: 000007555-FWA NO: 00015712). Inclusion criteria were as follows: age between 18 and 55 years, obesity (BMI>40), known OSA case with mild-to-moderate apnea–hypopnea index (<30), and scheduled for laparoscopic bariatric surgery under general anesthesia with rocuronium. Neuromuscular function monitoring was continued until the end of surgical procedure and at least 10 min after the train of four (TOF) ratio of 0.9. Anesthesia was maintained with sevoflurane. At the end of surgery and emergence of anesthesia, sugammadex group patients received 2 mg/kg ideal body weight sugammadex according to their ideal body weight, and the neostigmine group received neostigmine 50 μg/kg plus atropine 10 μg/kg. The time from start of sugammadex or neostigmine administration to recovery of the TOF ratio to 0.9 was calculated. All patients were extubated at TOF ratio of 0.9. They were monitored in the recovery room for 120 min after extubation. Oxygen saturation, respiratory rate, heart rate, and blood pressure were routinely monitored. Patients were placed in 30° head-up position. The patients were also monitored for the appearance of any sign of reoccurrence of muscle weakness and respiratory distress. Results The mean time for recovery to TOF of 0.9 was recorded from the time of administration of the drug. It was shorter in the sugammadex group than that in the neostigmine group. As regards the vital signs of both groups in the postoperative period, vitals were relatively stable in the sugammadex group, whereas there were significant tachypnea, hypoxia, and tachycardia in the other group. Respiratory distress signs were much more frequent in the neostigmine group than in the sugammadex group. This concludes that sugammadex may improve the postoperative respiratory outcome in OSA patients undergoing baraiatric surgery. Conclusion Sugammadex may improve the postoperative respiratory outcome in OSA patients undergoing baraiatric surgery.


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