Article Data

  • Views 2854
  • Dowloads 240

Original Research

Open Access

Post-operative respiratory outcomes associated with the use of sugammadex in laparoscopic colorectal cancer surgery: a retrospective, propensity score matched cohort study

  • Chahyun Oh1,†
  • Yumin Jo2,†
  • Seojin Sim2
  • Sangwon Yun2
  • Seungbin Jeon2
  • Woosuk Chung1,2
  • Seok-Hwa Yoon1,2
  • Chaeseong Lim1,2
  • Boohwi Hong1,2

1Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Korea

2Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Korea

DOI: 10.22514/sv.2020.16.0116 Vol.17,Issue 1,January 2021 pp.117-123

Published: 08 January 2021

*Corresponding Author(s): Chaeseong Lim E-mail:
*Corresponding Author(s): Boohwi Hong E-mail:

† These authors contributed equally.


Sugammadex can rapidly reverse neuromuscular blockade and has several advantages over cholinesterase inhibitors. It is unclear, however, whether administration of sugammadex in the absence of intraoperative deep neuromuscular blockade has direct clinical benefits. The present study retrospectively assessed the ability of sugammadex to prevent post-operative respiratory adverse events in patients undergoing laparoscopic colorectal surgery in the absence of routine deep neuromuscular blockade. The medical records of patients who underwent laparoscopic colorectal surgery from 2014 to 2018 in a tertiary care hospital were reviewed. Patients who underwent reversal of neuromuscular blockade with sugammadex or pyridostigmine were subjected to propensity score matching. To assess their relative effects on post-operative adverse respiratory events (defined as a composite of SpO2 < 94% in the post-anesthesia care unit, additional oxygen supplementation during ward transfer or stay, and emergency use of sugammadex in the post-anesthesia care unit), the incidence of these effects was compared in propensity score matched groups of patients treated with sugammadex or pyridostigmine. Of the 602 patients, 210 remained in each group after propensity score matching. The incidence of post-operative respiratory adverse events did not differ significantly in the two groups. These findings suggest that the unrestricted administration of sugammadex not preceded by intra-operative deep neuromuscular blockade does not have clinical benefits, when compared with pyridostigmine, in preventing post-operative respiratory adverse events.


Sugammadex; Rocuronium; Neuromuscular blocking agents; Laparoscopic surgery; Post-operative complication

Cite and Share

Chahyun Oh,Yumin Jo,Seojin Sim,Sangwon Yun,Seungbin Jeon,Woosuk Chung,Seok-Hwa Yoon,Chaeseong Lim,Boohwi Hong. Post-operative respiratory outcomes associated with the use of sugammadex in laparoscopic colorectal cancer surgery: a retrospective, propensity score matched cohort study. SignaVitae. 2021. 17(1);117-123.


[1] Baete S, Vercruysse G, Vander Laenen M, De Vooght P, Van Melkebeek J, Dylst D, Beran M, et al. The effect of deep versus moderate neuromuscular block on surgical conditions and postoperative respiratory function in bariatric laparoscopic surgery: a randomized, double blind clinical trial. Anesthesia and Analgesia. 2017; 124: 1469-1475.

[2] Naguib M. Sugammadex: another milestone in clinical neuromuscular pharmacology. Anesthesia and Analgesia. 2007; 104: 575-581.

[3] Suresh D, Carter J, Whitehead J, Goldhill DR, Flynn PJ. Cardiovascular changes at antagonism of atracurium: effects of different doses of premixed neostigmine and glycopyrronium in a ratio of 5 : 1. Anaesthesia. 1991; 46: 877-880.

[4] Martini C, Boon M, Bevers R, Aarts LP, Dahan A. Evaluation of surgical conditions during laparoscopic surgery in patients with moderate vs deep neuromuscular block. British Journal of Anaesthesia. 2014; 112: 498-505.

[5] Fuchs-Buder T, Schmartz D, Baumann C, Hilt L, Nomine-Criqui C, Meistelman C, et al. Deep neuromuscular blockade improves surgical conditions during gastric bypass surgery for morbid obesity: a randomised controlled trial. European Journal of Anaesthesiology. 2019; 36: 486-493.

[6] Koo BW, Oh AY, Na HS, Lee HJ, Kang SB, Kim DW, et al. Effects of depth of neuromuscular block on surgical conditions during laparoscopic colorectal surgery: a randomised controlled trial. Anaesthesia. 2018; 73: 1090-1096.

[7] Park S-K, Son YG, Yoo S, Lim T, Kim WH, Kim JT. Deep vs. moderate neuromuscular blockade during laparoscopic surgery: a systematic review and meta-analysis. European Journal of Anaesthesiology. 2018; 35: 867-875.

[8] von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Van-denbroucke JP, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Journal of Clinical Epidemiology. 2008; 61: 344-349.

[9] Abbott T, Fowler A, Pelosi P, Gama de Abreu M, Møller AM, Canet J, et al. A systematic review and consensus definitions for standardised end-points in perioperative medicine: pulmonary complications. British Journal of Anaesthesia. 2018; 120: 1066-1079.

[10] Lee DK. An introduction to propensity score matching methods. Anesthesia and Pain Medicine. 2016; 11: 130-148.

[11] Ho D, Imai K, King G, Stuart EA. MatchIt: Nonparametric preprocessing for parametric causal inference. Journal of Statistical Softwar. 2011; 42: 28.

[12] Olesnicky BL, Traill C, Marroquin-Harris FB. The effect of routine availability of sugammadex on postoperative respiratory complications: a historical cohort study. Journal Minerva Anestesiologica. 2017; 83: 248.

[13] O’Reilly-Shah VN, Lynde GC, Mitchell ML, Maffeo CL, Jabaley CS, Wolf FA. Initial experience with the unrestricted introduction of sugammadex at a large academic medical center: a retrospective observational study examining postoperative mechanical ventilation and efficiency outcomes. Korean Journal of Anesthesiology. 2018; 71: 374.

[14] Murphy GS, Szokol JW, Marymont JH, Greenberg SB, Avram MJ, Vender JS. Residual neuromuscular blockade and critical respiratory events in the postanesthesia care unit. Anesthesia and Analgesia. 2008; 107: 130-137.

[15] Martinez-Ubieto J, Ortega-Lucea S, Pascual-Bellosta A, Arazo-Iglesias I, Gil-Bona J, Jimenez-Bernardó T, et al. Prospective study of residual neuromuscular block and postoperative respiratory complications in patients reversed with neostigmine versus sugammadex. Journal Minerva Anestesiologica. 2016; 82: 735.

[16] Murphy GS, Szokol JW, Marymont JH, Greenberg SB, Avram MJ, Vender JS, et al. Intraoperative acceleromyographic monitoring reduces the risk of residual meeting abstracts and adverse respiratory events in the postanesthesia care unit. Anesthesiology. 2008; 109: 389-398.

[17] Brueckmann B, Sasaki N, Grobara P, Li MK, Woo T, de Bie J, et al. Effects of sugammadex on incidence of postoperative residual neuromuscular blockade: a randomized, controlled study. British Journal of Anaesthesia. 2015; 115: 743-751.

[18] Abad‐Gurumeta A, Ripollés‐Melchor J, Casans‐Francés R, Espinosa A, Martínez-Hurtado E, Fernández-Pérez C, et al. A systematic review of sugammadex vs neostigmine for reversal of neuromuscular blockade. Anaesthesia. 2015; 70: 1441-1452.

[19] Carron M, Zarantonello F, Tellaroli P, Ori C. Efficacy and safety of sugammadex compared to neostigmine for reversal of neuromuscular blockade: a meta-analysis of randomized controlled trials. Journal of Clinical Anesthesia. 2016; 35: 1-12.

[20] Alday E, Muñoz M, Planas A, Mata E, Alvarez C. Effects of neuromuscular block reversal with sugammadex versus neostigmine on postoperative respiratory outcomes after major abdominal surgery: a randomized-controlled trial. Canadian Journal of Anesthesia. 2019; 66: 1328-1337.

[21] Hristovska AM, Duch P, Allingstrup M, Afshari A. Efficacy and safety of sugammadex versus neostigmine in reversing neuromuscular blockade in adults. Cochrane Database of Systematic Reviews. 2017; 8: CD012763.

[22] Carron M, Zarantonello F, Lazzarotto N, Tellaroli P, Ori C. Role of sugammadex in accelerating postoperative discharge: a meta-analysis. Journal of Clinical Anesthesia. 2017; 39: 38-44.

[23] Kirmeier E, Eriksson LI, Lewald H, Jonsson Fagerlund M, Hoeft A, Hollmann M, et al. Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): A multicentre, prospective observational study. The Lancet Respiratory Medicine. 2019; 7: 129-140.

[24] Kopman AF, Naguib M. Laparoscopic surgery and muscle relaxants: is deep block helpful? Anesthesia and Analgesia. 2015; 120: 51-58.

[25] Choi E, Oh A, Koo B, Hwang JW, Han JW, Seo KS, et al. Comparison of reversal with neostigmine of low‐dose rocuronium vs. reversal with sugammadex of high‐dose rocuronium for a short procedure. Anaesthesia. 2017; 72: 1185-1190.

[26] Cappellini I, Ostento D, Loriga B, Tofani L, De Gaudio AR, Adembri C. Comparison of neostigmine vs. sugammadex for recovery of muscle function after neuromuscular block by means of diaphragm ultrasonography in microlaryngeal surgery: a randomised controlled trial. European Journal of Anaesthesiology. 2020; 37: 44-51.

[27] Mouri H, Jo T, Matsui H, Fushimi K, Yasunaga H. Effect of Sugammadex on postoperative Myasthenic crisis in myasthenia gravis patients: propensity score analysis of a Japanese Nationwide database. Anesthesia and Analgesia. 2020; 130: 367-373.

[28] Austin PC, Grootendorst P, Anderson GM. A comparison of the ability of different propensity score models to balance measured variables between treated and untreated subjects: A Monte Carlo study. Statistics in Medicine. 2007; 26: 734-753.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 1.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time