Effects Of Sugammadex On Enhanced Recovery Of Severely Obese Patients After Laparoscopic Bariatric Surgery

Background and objectiveIn recent years,rapid increases in the global overweight and obese population and annually increased incidences of metabolic diseases such as obesity-related hypertension,coronary heart disease,diabetes,and obstructive sleep apnea(OSA)have become public health issues that severely affect the physical and mental health of people.Bariatric surgery is recognized as the most effective method for the treatment of obesity and obesity-associated metabolic diseases.For severe obesity with BMI≥ 40 kg/m2,bariatric surgery strikingly reduces all-cause mortality and the risk of readmission within 10 years.However,severe obesity have decreased lung compliance and reduced functional residual capacity and are prone to develop pulmonary complications following surgery.The residual effects of anesthetics,especially muscle relaxants,augments the incidence of upper airway obstruction and pulmonary complications and hinders the patient’s recovery.Sugammadex is a new type of specific muscle relaxant antagonist.Sugammadex can fully and rapidly reverse the moderate and deep muscle relaxation evoked by Rocuronium and shorten the extubation time of patients under anesthesia,contributing to reductions in the incidence of postoperative residual curarization(PORC),and hospitalization time.However,current studies mostly focus on medical reports of the prognostic indicators for outcomes,such as hospital stay,postoperative complications,etc.With the extension of the enhanced recovery after surgery(ERAS)theory,the application of Patient-reported outcomes(PRO)has become a trend in the evaluation of ERAS schemes.However,there is a lack of research in a severely obese population.Therefore,this study utilized the Quality of Recovery-15(QoR-15)scale,to explore the effect of Sugammadex on the recovery quality of severely obese patients post-bariatric surgery,so as to offer a reference for the rapid recovery plans after bariatric surgery.MethodsA total of 180 patients who underwent elective laparoscopic bariatric surgery in Zhengzhou central Hospital Affiliated To Zhengzhou University from February 2021 to December 2021(aged 18～65 years;BMI ≥ 40 kg/m2;The New York Heart Association cardiac function grade I or II)were enrolled.The patients were assigned to the Sugammadex(S)group and Neostigmine(N)group at randomization.Perioperative management of patients in both groups was conducted in compliance with the standard ERAS procedure.At the end of the surgery,the reappearance of T2 was monitored under train-of-four(TOF)stimulation,and the patients in the S group were given Sugammadex(2 mg/kg)while patients in the N group were given Neostigmine(0.04 mg/kg)+Atropine(0.02 mg/kg).The main outcome measures included QoR-15 scores of patients at 24h after surgery.Secondary outcome measure:time from antagonism of muscle relaxation until the TOF ratio≥ 0.9;extubation time post surgery;systolic blood pressure,diastolic blood pressure,heart rate,and SpO2 when the patient was transmitted to the postanesthesia care unit(PACU);the minimal SpO2,incidence of hypoxic episodes within the PACU;the TOF value 30 minutes after extubation;PORC,Ramsay sedation score,and PACU stay time;the pain numeric rating scale(NRS)scores during rest and exercise within PACU,12 h,24 h,and 48 h after surgery,the cumulative consumption of analgesic pump drugs,and the number of patients received rescue analgesia;SpO2 at 12 h,24 h,and 48 h after surgery,and incidences of hypoxemia,the incidences of dizziness,postoperative nausea and vomiting,pulmonary complications;the time of first off-bed activity and length of hospital stay.ResultsThe two groups exhibited no significant difference concerning the total QoR-15 scores 24 h after surgery.But the patients in the S group showed superior scores of the three indicators in the QoR-15 scores(feeling rested,able to return to work or usual home activities,and feeling worried or anxious)to those in the N group(p<0.05).The time until the TOF ratio≥ 0.9,the time of tracheal extubation,the incidence of PORC within PACU,PACU stay time,the time of first off-bed activity,and hospital stay time decreased in the S group as compared to the N group(p<0.05).Reversely,a higher TOF value 30 min after extubation was detected in the S group relative to the N group(p<0.05).No noticeable differences were observed between the two groups in terms of systolic blood pressure,diastolic blood pressure,heart rate,and SpO2 at the time of transfer to the PACU,the minimal SpO2,the incidence of hypoxic episodes within the PACU,Ramsay sedation score,NRS scores during rest and exercise within the PACU,12 h,24 h,and 48 h after surgery,postoperative consumption of analgesic pump drugs,rescue analgesia times,SpO2 at 12 h,24 h,and 48 h after surgery,the incidence of hypoxemia,incidences of dizziness,postoperative nausea and vomiting,pulmonary complications.ConclusionThis study unveiled that Sugammadex did not significantly improve the QoR-15 scores in the severely obese patients who underwent laparoscopic bariatric surgery,but it reduce the incidence of PORC,shorten the PACU stay time,postoperative recovery time until first off-bed activity,reduce the length of hospital stay.Therefore,Sugammadex is beneficial to the enhanced recovery of severely obese patients.