Reversal of neuromuscular blockade after coronary artery bypass grafting: a randomized control trial.

BACKGROUND: Early extubation in cardiac surgery improves recovery and outcomes. Extubation of the airway after cardiac surgery in the operating room or in the immediate postoperative period is a key component of the optimization of outcomes in cardiac surgical patients. Specific objectives of this study included measuring time to extubation with secondary outcomes of post-extubation vital signs, lung function, and esophageal motility. Exploratory parameters included ICU stay and re-intubation in 24 h. METHODS: In this study, we compare two groups of patients undergoing coronary bypass grafting surgery (CABG) under general anesthesia with muscle relaxation. Reversal of neuromuscular blockade randomized to group 1: neostigmine and group 2: sugammadex. A standard anesthetic protocol was followed throughout the perioperative period in each of these patients with the goal of in-operating room extubation. A two-sample t-test and/or linear model was used in the data analysis. RESULTS: 4 subjects were not extubated in the neostigmine group versus 1 subject in the sugammadex group. The average time to extubation in the neostigmine group was 10.4 min, (STDEV: 5.9 min) and sugammadex was 6 min, (STDEV: 4.7 min). p = 0.001 (ANOVA). Significant secondary outcome measures included patients who received sugammadex had higher heart rates at the second measurement (85.0) vs. neostigmine (79.5) p = 0.047 and higher systolic blood pressures at the second measurement point for sugammadex (111.7) vs. neostigmine (103.9) p = 0.023. 11/36 (30%) failed the Functional Dysphasia Screen in the neostigmine group versus 5/35 (14%) in the sugammadex. Subjects in the neostigmine group had an average ICU stay of 40.1 +/- 32.4 h versus 35.6 +/- 15.8 in the sugammadex group. 2 patients in the neostigmine group were re-intubated and 1 patient was placed on non-invasive positive pressure ventilation vs. no airway interventions in the sugammadex group. CONCLUSIONS: Based on the results of this study, utilizing sugammadex for reversal of neuromuscular blockade after CABG may increase early extubation in the operating room, decrease the re-intubation rates, provide a very consistent level of muscle strength for lung function, and may improve postoperative esophageal dysmotility. TRIAL REGISTRATION: ClinicalTrials.gov NCT03939923, Registration date of Feb 2, 2019.