Editorial  |   June 2020
Sugammadex and Postoperative Pulmonary Complications: Is Stronger Evidence Required?
Author Notes
  • From the Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Victoria, Australia.
  • This editorial accompanies the article on p. 1371.
    This editorial accompanies the article on p. 1371.×
  • Accepted for publication March 2, 2020.
    Accepted for publication March 2, 2020.×
  • Address correspondence to Dr. Leslie: kate.leslie@mh.org.au
Article Information
Editorial
Editorial   |   June 2020
Sugammadex and Postoperative Pulmonary Complications: Is Stronger Evidence Required?
Anesthesiology 6 2020, Vol.132, 1299-1300. doi:https://doi.org/10.1097/ALN.0000000000003282
Anesthesiology 6 2020, Vol.132, 1299-1300. doi:https://doi.org/10.1097/ALN.0000000000003282
Residual neuromuscular blockade is common and associated with increased risk of airway obstruction, hypoxemia, and postoperative pulmonary complications.1  Sugammadex reverses moderately deep rocuronium-induced blockade 7 times faster and deep blockade 17 times faster than neostigmine, and only 13 patients need to be treated with sugammadex rather than neostigmine to avoid residual neuromuscular blockade.2  However, despite this strong biologic rationale for a reduction in postoperative pulmonary complications with sugammadex, evidence from large well-conducted multicenter studies is lacking.
In this issue of Anesthesiology, Kheterpal et al.3  report the results of the largest observational study to date investigating the association between choice of reversal agent and postoperative pulmonary complications (the sugammadex versus neostigmine for reversal of neuromuscular blockade and postoperative pulmonary complications [STRONGER] study). They included 45,712 adults admitted to 12 academic and community hospitals in the United States for elective noncardiac surgery. Of these, 22,856 patients received sugammadex and 22,856 patients received neostigmine for reversal of rocuronium or vecuronium. The incidence of a composite of pneumonia, respiratory failure, pneumothorax, and other major pulmonary complications was 3.5% in the sugammadex group and 4.8% in the neostigmine group (adjusted odds ratio, 0.70; 95% CI, 0.63–0.77; number needed to treat 77 to avoid a major pulmonary complication in one patient in this population). Given the millions of people at risk, the suffering of patients who experience postoperative pulmonary complications, and the financial implications for the healthcare system, this 30% reduction could be practice-changing if it is true.