Publication details

Low-dose or high-dose rocuronium reversed with neostigmine or sugammadex for cesarean delivery anesthesia: A randomized controlled non-inferiority trial of time to tracheal intubation and extubation.

Authors

ŠTOURAČ Petr ADAMUS Milan SEIDLOVÁ Dagmar PAVLÍK Tomáš JANKŮ Petr KŘIKAVA Ivo MROZEK Zdenek PROCHÁZKA Martin KLUČKA Jozef ŠTOUDEK Roman BÁRTÍKOVÁ Ivana KOSINOVÁ Martina HARAZIM Hana ROBOTKOVÁ Hana HEJDUK Karel HODICKÁ Zuzana KIRCHNEROVA Martina FRANČÁKOVÁ Jana OBARE PYSZKOVA Lenka HLOZKOVA Jarmila ŠEVČÍK Pavel

Year of publication 2016
Type Article in Periodical
Magazine / Source Anesthesia and Analgesia
MU Faculty or unit

Faculty of Medicine

Citation
Doi http://dx.doi.org/10.1213/ANE.0000000000001197
Field Other medical specializations
Keywords cesarean delivery; active reversla of neuromuscular blockade; intubation conditions; postoperative complications
Description BACKGROUND: Rocuronium for cesarean delivery under general anesthesia is an alternative to succinylcholine for rapid-sequence induction of anesthesia because of the availability of sugammadex for reversal of neuromuscular blockade. However, there are no large well-controlled studies in women undergoing general anesthesia for cesarean delivery. The aim of this noninferiority trial was to determine whether rocuronium and sugammadex confer benefit in time to tracheal intubation (primary outcome) and other neuromuscular blockade outcomes compared with succinylcholine, rocuronium, and neostigmine in women undergoing general anesthesia for cesarean delivery. RESULTS: We enrolled 240 parturients. The mean time to tracheal intubation was 2.9 seconds longer in the ROC group (95% confidence interval, -5.3 to 11.2 seconds), noninferior compared with the SUX group. Absence of laryngoscopy resistance was greater in the ROC than in the SUX groups (ROC, 87.5%; SUX, 74.2%; P = 0.019), but there were no differences in vocal cord position (P = 0.45) or intubation response (P = 0.31) between groups. No statistically significant differences in incidence of anesthesia complications or in neonatal outcome were found (10 minute Apgar score, P = 0.07; umbilical artery pH, P = 0.43). The incidence of postpartum myalgia was greater in the SUX group (ROC 0%; SUX 6.7%; P = 0.007). The incidence of subjective complaints was lower in the ROC group (ROC, 21.4%; SUX, 37.5%; P = 0.007). CONCLUSIONS: We conclude that rocuronium for rapid-sequence induction is noninferior for time to tracheal intubation and is accompanied by more frequent absence of laryngoscopy resistance and lower incidence of myalgia in comparison with succinylcholine for cesarean delivery under general anesthesia.

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