Influence of Reversal of Neuromuscular Blockade On Perioperatıve Arrhythmia Occurrence
Rabia Özdemir, Mehmet Onur Omaygenç, Yavuz Demiraran,
Turkish Hospital Doha, Department Of Anesthesiology, Doha, QatarIstanbul Medipol University, Ims, Cardiology Department, Istanbul, TurkeyIstanbul Medipol University, Department Of Anesthesiology And Reanimation, Istanbul, Turkey
Background It was speculated that agents used for reversal of neuromuscular blockade (NMB) may provoke cardiac arrhythmia. However, this statement was mostly based on assumptions considering the alterations observed on rest electrocardiogram (e.g, QT prolongation). Neostigmine and sugammadex were also reported to cause bradycardia and even asystole. These severe adverse events less frequently occurred with the latter. Here we sought to compare the rates of documented arrhythmia events after administration of these agents. Materials 77 ASA Class I-III patients were recruited. Participants were grouped according to the agent used for reversal of NMB; neostigmine, Group N and sugammadex, Group S. Propofol was used for anesthesia maintenance in both groups. Reversal of NMB was confirmed by train-of-four ratio measurement. Before induction of anesthesia, a rhythm Holter device was attached and surface ECGs were recorded for 12 hours. Minimum and mean heart rates were noted. Heart rate variability analyses were performed. Significant arrhythmia episodes were particularly specified. QT dispersion was calculated from 12-lead ECGs obtained before and after the operation. Results Demographic features were mostly comparable among treatment groups. Extubation time was significantly shorter in Group S as expected (mins, 7.4±5.3 vs 2.5±2.2;p< 0.001). Surprisingly, heart rate during reversal of NMB was lower in Group S (beats/min, 80 (45-121) vs 66 (46-126);p=0.01). Two pause episodes and a temporary high-grade AV block were detected in Group N. Moreover, composite arrhythmia end-point was reached more frequently in Group N (Table 1). According to the results of logistic regression analysis, history of arrhythmia, lower minimum heart rate, and increased QT-dispersion on postoperative ECG were independent predictors of postoperative arrhythmia events (Figure 1). Conclusion Clinically relevant arrhythmia was less frequently encountered in participants receiving sugammadex for reversal of NMB. However, utilization of neostigmine was not identified as an independent predictor for postoperative arrhythmia in our population.
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