Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2014.10.003
Brazilian Journal of Anesthesiology
Scientific Article

The effect of sugammadex on postoperative cognitive function and recovery

O efeito de sugamadex sobre a função cognitiva e recuperação no pós-operatório

Özcan Piş; kin; Gamze Küçükosman; Deniz Utku Altun; Murat Çimencan; Banu Özen; Bengü Gülhan Aydı; n; Rahş; an Dilek Okyay; Hilal Ayoğ; lu; ; ı; l Özkoçak Turan

Downloads: 0
Views: 749

Abstract

Abstract Background and objective: Sugammadex is the first selective relaxant binding agent. When compared with neostigmine, following sugammadex administration patients wake earlier and have shorter recovery times. In this study, we hypothesized that fast and clear awakening in patients undergoing general anesthesia has positive effects on cognitive functions in the early period after operation. Methods: Approved by the local ethical committee, 128 patients were enrolled in this randomized, prospective, controlled, double-blind study. Patients were allocated to either Sugammadex group (Group S) or the Neostigmine group (Group N). The primary outcome of the study was early postoperative cognitive recovery as measured by the Montreal Cognitive Assessment (MoCA) and Mini Mental State Examination (MMSE). After baseline assessment 12-24 h before the operation. After the operation, when the Modified Aldrete Recovery Score was ≥9 the MMSE and 1 h later the MoCA tests were repeated. Results: Although there was a reduction in MoCA and MMSE scores in both Group S and Group N between preoperative and postoperative scores, there was no statistically significant difference in the slopes (p > 0.05). The time to reach TOF 0.9 was 2.19 min in Group S and 6.47 min in Group N (p < 0.0001). Recovery time was 8.26 min in Group S and 16.93 min in Group N (p < 0.0001). Conclusion: We showed that the surgical procedure and/or accompanying anesthetic procedure may cause a temporary or permanent regression in cognitive function in the early postoperative period. However, better cognitive performance could not be proved in the Sugammadex compared to the Neostigmine.

Keywords

Sugammadex, Neostigmine, Postoperative cognitive dysfunction, MMSE, MoCA

Resumo

Resumo Justificativa e objetivo: Sugamadex é o primeiro agente de ligação relaxante seletivo. Após a administração de sugamadex, os tempos de despertar e de recuperação dos pacientes são menores, em comparação com neostigmina. Neste estudo, a hipótese foi que um despertar mais rápido e claro dos pacientes submetidos à anestesia geral tem efeitos positivos sobre as funções cognitivas no pós-operatório imediato. Métodos: Após a aprovação do Comitê de Ética local, 128 pacientes foram incluídos neste estudo prospectivo, randômico, controlado e duplo-cego. Os pacientes foram designados para o grupo sugamadex (Grupo S) ou grupo neostigmina (Grupo N). O desfecho primário do estudo foi a recuperação cognitiva no pós-operatório imediato, de acordo com a mensuração da Avaliação de Montreal da Função Cognitiva (MoCA) e com o Mini Exame do Estado Mental (MMSE), após a avaliação inicial 12-24 h antes da operação. Após a operação, quando o escore de recuperação de Aldrete modificado era ≥ 9, o teste MMSE e, uma hora depois, o teste MoCA foram repetidos. Resultados: Embora tenha havido uma redução nos escores de MoCA e MMSE tanto no Grupo S quanto no Grupo N, entre os escores pré- e pós-operatório não houve diferença estatisticamente significativa nas reduções (p > 0,05). O tempo para atingir TOF 0,9 foi de 2,19 min no Grupo S e de 6,47 min no Grupo N (p < 0,0001). O tempo de recuperação foi de 8,26 min no Grupo S e de 16,93 min no Grupo N (p < 0,0001) Conclusão: Mostramos que o procedimento cirúrgico e/ou procedimento anestésico de acompanhamento pode causar uma regressão temporária ou permanente da função cognitiva no pós-operatório imediato. No entanto, um desempenho cognitivo melhor não pode ser provado no grupo sugamadex em comparação com o grupo neostigmina.

Palavras-chave

Sugamadex, Neostigmina, Disfunção cognitiva no pós-operatório, MMSE, MoCA

References

Funder KS, Steinmetz J, Rasmussen LS. Methodological issues of postoperative cognitive dysfunction. Semin Cardiothoracic Vasc Anesth. 2010;14:119-22.

Sauer AM, Kalkman C, Dijk DV. Postoperative cognitive decline. J Anesth. 2009;23:256-9.

Xu T, Bo L, Wang J. Risk factors for early postoperative cognitive dysfunction after non-coronary bypass surgery in Chinese population. J Cardiothorac Surg. 2013;8:204.

Ologunde R, Ma D. Do inhalation anesthetics cause cognitive dysfunction?. Acta Anaesthesiol Taiwan. 2011;49:149-53.

Culley DJ, Baxter M, Yukhananov R. The memory effects of general anesthesia persist for weeks in young and a ged rats. Anesth Analg. 2003;96:1004-9.

Bianchi SL, Tran T, Liu C. Brain and behavior changes in 12-month-old Tg2576 and non transgenic mice exposed to anesthetics. Neurobiol Aging. 2008;29:1002-10.

Wan Y, Xu J, Ma D. Postoperative impairment of cognitive function in rats: a possible role for cytokine-mediated inflamation in the hippocampus. Anesthesiology. 2007;106:436-43.

Chan MT, Cheng BC, Lee TM. BİS-guided anesthesia decreases postoperative delirium and cognitive decline. J Neurosurg Anesthesiol. 2013;25:33-42.

Bom A, Bradley M, Cameron K. A novel concept of reversing neuromuscular block: chemical encapsulation of rocuronium bromide by a cyclodextrin-based synthetic host. Angew Chem Int Ed Engl. 2002;4:266-70.

Staals LM, Dreissen JJ, Van Egmond J. Train-of-four ratio recovery of ten precedes twitch recovery when neuromuscular block is reversed by Sugammadex. Acta Anaesthesiol Scand. 2011;55:700-7.

Gelder G, Niskanen M, Laurilia P. A randomised controlled trial comparing sugammadex and neostigmin at diffirent depths of neuromuscular blokade in patients under going laparoscopic surgery. Anaesthesia. 2012;67:991-8.

Jones RK, Caldwell JE, Brull SJ. Reversal of profound rocuronium-induced blockade with Sugammadex: a randomized comparison with neostigmine. Anesthesiology. 2008;109:816-24.

Khuenl-Brady KS, Wattwil M, Vanacker BF. Sugammadex provides faster reversal of vecuronium-induced neuromuscular blockade compared with neostigmine: a multicenter, randomized, controlled trial. Anesth Analg. 2010;110:64-73.

Folstein MF, Folstein SE, McHugh PR. ‘Mini-mental state’. A practical method for grading the cognitive state of patient fort he clinician. J Psychiatr Res. 1975;12:189-98.

. .

Aldrete JA, Kroulik D. A post-anesthetic recovey score. Anesth Analg. 1970;49:924-33.

Aitken RC. Measurement of feeling using visual analogue skales. Proc R Soc Med. 1969;62:989-93.

Portney LG, Watkins MP. Foundations of clinical research applications to practice. 2009:653-60.

Moller JT, Cluitmans P, Rasmussen LS. Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators. International Study of Post-Operative Cognitive Dysfunction. Lancet. 1998;351:857-61.

Newman S, Stygall J, Hirani S. Postoperative cognitive dysfunction after non cardiac surgery. Anesthesiology. 2007;106:572-90.

Johnson TW, Monk T, Rasmussen LS. Postoperative cognitive dysfunction in middle-aged patients. Anesthesiology. 2002;96:1351-7.

Steinmetz J, Siersma V, Kessing LV. İs postoperative cognitive dysfunction a risc factor for dementia. A cohort follow-upstudy. Br J Anaesth. 2013;110:92-7.

Selekler K, Cangöz B, Uluç S. Montreal bilişsel değerlendirme ölçeği (MOBİD)’in hafif bilişsel bozukluk ve Alzheimer hastalarını ayırt edebilme gücünün incelenmesi. Turk J Geriatr. 2010;13:166-71.

Güngen C, Ertan T, Eker E. Standardize mini mental test’in Türk toplumunda hafif demans tanısında geçerlilik ve güvenirliği. Turk Psikiyatri Derg. 2002;13:273-81.

Koc F, Turan G, Subası D. Comparison of sugammadex and neostigmin in short term surgery. 1694.

Pongrácz A, Szatmári S, Nemes R. Reversal of neuromuscular blockade with Sugammadex at the reappearance of four twitches to train-of-four stimulation. Anesthesiology. 2013;119:36-42.

Bronco A, İngelmo PB, Aprigliano M. Xenon anaesthesia produces beter early postoperative cognitive recovery than sevoflurane anaesthesia. Eur J Anaesthesiol. 2010;10:912-6.

Coburn M, Baumert JH, Roertgen D. Emergence and early cognitive function in the elderly after xenon or desflurane anaesthesia: a double-blinded randomized controlled trial. Br J Anaesth. 2007;98:756-62.

Rasmussen LS, Schmehl W, Jakobsson J. Comparison of xenon with propofol for supplementary general anaesthesia for knee replacement: a randomized study. Br J Anaesth. 2006;97:154-9.

5dcd6f510e88258605bf58f2 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections