Sugammadex for Fast-Track Surgery in Children Undergoing Cardiac Surgery: A Randomized Controlled Study
Study Type: RCT
Methods: 60 children having cardiac surgery
Findings: Sugammadex substantially shortens time to TOF >0.9 and extubation time compared with standard reversal.
This group used a rocuronium infusion intraoperatively with a target of TOF <0.05, which was ceased at the end of surgery (precise timing unknown) and reversal was done when they reached PICU.
Combined with the reasonable doses of sufentanil for cardiac surgery, this explains the relatively slow extubation time (31 min) even with sugammadex, despite reaching TOF>0.9 after 3.4 min. However, TOF>0.9 was reached 76 minutes after reversal administration at TOF>0.25 and extubation at 125 min. Whilst this is still a fast-track extubation (<4hrs from end of surgery), one cannot use this technique for ultra-fast track operating theatre extubations.
The take home from this study is that sugammadex is clearly far superior to neostigmine/atropine reversal from deep levels of muscle relaxation, but the other drugs one uses play a big role in whether it actually helps a fast-track extubation process.
Reviewed by Dr Justin Skowno