{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T16:25:19Z","timestamp":1791390319274,"version":"4.3.3"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2024,6,7]],"date-time":"2024-06-07T00:00:00Z","timestamp":1717718400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,3]]},"abstract":"\n BACKGROUND:<\/jats:title>\n Residual neuromuscular blockade can be associated with serious postoperative complications. Sugammadex is a newer neuromuscular blocking drug (NMBD) reversal agent that rapidly and completely reverses rocuronium. Whether sugammadex has any advantages over neostigmine in morbidly obese patients with obstructive sleep apnea (OSA) is unclear. We investigated whether sugammadex would reduce discharge time from the operating room (OR) compared with neostigmine in morbidly obese patients with OSA undergoing bariatric surgery.<\/jats:p>\n <\/jats:sec>\n \n METHODS:<\/jats:title>\n This was a prospective, double-blinded randomized controlled superiority trial with 2 parallel groups. Patients were randomized 1:1 into reversal of NMBD with sugammadex or neostigmine. Our inclusion criteria were morbidly obese adult patients with OSA undergoing elective bariatric surgery under general anesthesia. Our exclusion criteria were allergy to rocuronium, sugammadex or neostigmine, malignant hyperthermia, hepatic or renal insufficiency, neuromuscular diseases, and an inability to give consent. The primary outcome was the time from administration of the NMBD reversal agent to discharge from the OR. Secondary outcomes included the time from administration of the NMBD reversal agent to the time the patient opened eyes to command, and the time to extubation. The Mann-Whitney test was used to compare the outcomes between treatment groups.<\/jats:p>\n <\/jats:sec>\n \n RESULTS:<\/jats:title>\n \n We randomized 120 patients into 2 groups of 60 patients. Overall median body mass index (BMI) was 48.1 kg\/m\n 2<\/jats:sup>\n ([interquartile range, IQR]) [43.0\u201353.5]. The time from drug administration to discharge from OR was 13.0 minutes [10.0\u201317.0] in the sugammadex group and 13.5 minutes [11.0\u201318.3] in the neostigmine group (\n P<\/jats:italic>\n = .27). The treatment effect estimate with a bootstrapped 95% confidence interval [CI] for time from admission to discharge from OR was \u22120.5 [\u22122.5 to 3]. No differences were observed in postoperative complications and other secondary outcomes.\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n No difference was observed in OR discharge time in morbidly obese patients with OSA when sugammadex was administered instead of neostigmine.<\/jats:p>\n <\/jats:sec>","DOI":"10.1213\/ane.0000000000007013","type":"journal-article","created":{"date-parts":[[2024,6,7]],"date-time":"2024-06-07T13:01:40Z","timestamp":1717765300000},"page":"568-576","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":11,"title":["Impact of Sugammadex Versus Neostigmine Reversal on Postoperative Recovery Time in Patients With Obstructive Sleep Apnea Undergoing Bariatric Surgery: A Double-Blind, Randomized Controlled Trial"],"prefix":"10.1213","volume":"140","author":[{"given":"Olawale","family":"Ajetunmobi","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Surrey Memorial Hospital, Surrey, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anahi","family":"Perlas","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wesley","family":"Rajaleelan","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stella","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, University Health Network, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ella","family":"Huszti","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, University Health Network, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Jackson","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Toronto, University Health Network, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frances","family":"Chung","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada"},{"name":"Department of Anesthesiology and Pain Medicine, Women\u2019s College Hospital, University of Toronto, Toronto, Ontario, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,6,7]]},"reference":[{"key":"R1-20250224","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1213\/ANE.0000000000000757","article-title":"The RECITE study: a Canadian prospective, multicenter study of the incidence and severity of residual neuromuscular blockade.","volume":"121","author":"Fortier","year":"2015","journal-title":"Anesth Analg"},{"key":"R2-20250224","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1213\/ANE.0b013e3181da832d","article-title":"Residual neuromuscular block: lessons unlearned. Part I: definitions, incidence, and adverse physiologic effects of residual neuromuscular block.","volume":"111","author":"Murphy","year":"2010","journal-title":"Anesth Analg"},{"key":"R3-20250224","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1097\/ACO.0000000000000395","article-title":"Residual neuromuscular blockade: management and impact on postoperative pulmonary outcome.","volume":"29","author":"Fuchs-Buder","year":"2016","journal-title":"Curr Opin Anaesthesiol"},{"key":"R4-20250224","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1213\/ane.0b013e31816d1268","article-title":"Residual neuromuscular blockade and critical respiratory events in the postanesthesia care unit.","volume":"107","author":"Murphy","year":"2008","journal-title":"Anesth Analg"},{"key":"R5-20250224","doi-asserted-by":"crossref","first-page":"1865","DOI":"10.1007\/s00405-012-1948-0","article-title":"Obstructive sleep apnea is underrecognized and underdiagnosed in patients undergoing bariatric surgery.","volume":"269","author":"Ravesloot","year":"2012","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"R6-20250224","doi-asserted-by":"crossref","first-page":"1833","DOI":"10.1089\/jwh.2009.1859","article-title":"Predicting obstructive sleep apnea among women candidates for bariatric surgery.","volume":"19","author":"Sharkey","year":"2010","journal-title":"J Women's Health (2002)"},{"key":"R7-20250224","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1097\/ALN.0000000000000041","article-title":"Factors associated with postoperative exacerbation of sleep-disordered breathing.","volume":"120","author":"Chung","year":"2014","journal-title":"Anesthesiology"},{"key":"R8-20250224","doi-asserted-by":"crossref","first-page":"1321","DOI":"10.1213\/ANE.0000000000001178","article-title":"Does obstructive sleep apnea influence perioperative outcome? A qualitative systematic review for the Society of Anesthesia and Sleep Medicine Task Force on preoperative preparation of patients with sleep-disordered breathing.","volume":"122","author":"Opperer","year":"2016","journal-title":"Anesth Analg"},{"key":"R9-20250224","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1093\/bja\/aex341","article-title":"Death or near-death in patients with obstructive sleep apnoea: a compendium of case reports of critical complications.","volume":"119","author":"Subramani","year":"2017","journal-title":"Br J Anaesth"},{"key":"R10-20250224","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1213\/ane.0b013e318174df8b","article-title":"Postoperative hypoxemia in morbidly obese patients with and without obstructive sleep apnea undergoing laparoscopic bariatric surgery.","volume":"107","author":"Ahmad","year":"2008","journal-title":"Anesth 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and safety of sugammadex versus neostigmine in reversing neuromuscular blockade in morbidly obese adult patients: a systematic review and meta-analysis.","volume":"15","author":"Subramani","year":"2021","journal-title":"Anesth Essays Res"},{"key":"R15-20250224","doi-asserted-by":"crossref","first-page":"1496","DOI":"10.1007\/s11695-015-1758-8","article-title":"Lean body weight is not a weight scalar for estimating drug doses in morbid obesity.","volume":"25","author":"Friesen","year":"2015","journal-title":"Obes Surg"},{"key":"R16-20250224","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1213\/ANE.0000000000004211","article-title":"Correct baseline comparisons in a randomized trial.","volume":"129","author":"Schober","year":"2019","journal-title":"Anesth Analg"},{"key":"R17-20250224","doi-asserted-by":"crossref","first-page":"3083","DOI":"10.1002\/sim.3697","article-title":"Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples.","volume":"28","author":"Austin","year":"2009","journal-title":"Stat Med"},{"key":"R18-20250224","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.jclinane.2016.07.030","article-title":"Operating room discharge after deep neuromuscular block reversed with sugammadex compared with shallow block reversed with neostigmine: a randomized controlled trial.","volume":"35","author":"Putz","year":"2016","journal-title":"J Clin Anesth"},{"key":"R19-20250224","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1111\/jep.13151","article-title":"Sugammadex in Ontario hospitals: access and institutional policies.","volume":"26","author":"Cohen","year":"2020","journal-title":"J Eval Clin Pract"},{"key":"R20-20250224","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1093\/bja\/aer330","article-title":"Randomized comparison of sugammadex and neostigmine for reversal of rocuronium-induced muscle relaxation in morbidly obese undergoing 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