TOPLINE

Among adults who underwent upper gastrointestinal (GI) endoscopic procedures with rocuronium-induced neuromuscular block, reversal using sugammadex was associated with a lower risk for the failure of tracheal extubation within 30 days than was reversal using neostigmine.

METHODOLOGY

• Researchers conducted a retrospective cohort study to compare respiratory outcomes of two reversal methods in adults who underwent upper GI endoscopic procedures with neuromuscular block induced by rocuronium between January 2016 and October 2025.
• They used the TriNetX US electronic health record network to identify patients who received same-day reversal with sugammadex or neostigmine. After propensity score matching, each group had 7865 patients (mean age, 56 years; about half were male).
• The primary endpoint was the failure of tracheal extubation, defined as tracheal reintubation or the need for mechanical ventilation within 30 days of the procedure. Secondary outcomes included lung atelectasis or collapse, unplanned admission to the ICU, pneumonia, arrhythmia, and 30-day all-cause mortality.
• A prespecified subgroup analysis compared 4624 matched pairs of patients without chronic pulmonary disease or asthma to evaluate effects in those with normal lung function at baseline.

TAKEAWAY

• Tracheal extubation failed less frequently in patients who received sugammadex vs neostigmine (3.88% vs 5.79%). A risk ratio of 1.49 (P < .0001) and an absolute risk difference of 1.91% favored sugammadex.
• Patients who received sugammadex vs neostigmine had less frequent lung atelectasis or collapse (6.74% vs 7.76%) and unplanned admission to the ICU within 30 days (8.27% vs 9.45%). The respective risk ratios of 1.15 and 1.14 favored sugammadex (P < .05 for both).
• The risk for aspiration pneumonia, postoperative arrhythmia, and 30-day all-cause mortality did not differ between the two groups.
• In the subgroup without chronic pulmonary disease or asthma, sugammadex was associated with a lower risk for the failure of tracheal extubation, unplanned admission to the ICU, and the use of noninvasive ventilation (P < .05 for all).

IN PRACTICE

“While definitive causal inference would require randomized trials specifically targeting this risk population, our findings add to a growing body of evidence linking residual neuromuscular blockade to adverse respiratory events and support the view that upper GI endoscopy carries sufficient intrinsic respiratory risk to justify routine quantitative neuromuscular monitoring and reliable antagonism strategies,” the researchers of the study reported.

SOURCE

The study was led by Yung-Fong Tsai, Chang Gung Memorial Hospital, Taoyuan, Taiwan. It was published online on June 19 in Anaesthesia.

LIMITATIONS

The study was observational and could not exclude residual confounding from factors not captured in the database. Researchers lacked quantitative measurements of train-of-four and information on how anesthesia was managed during surgery. They relied on administrative codes to define comorbidities and pulmonary complications, which may have led to misclassification.

DISCLOSURES

The authors did not declare any sources of external funding or competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.