Sugammadex neuromuscular blockade reversal associated with lower postoperative arterial carbon dioxide levels after congenital cardiac surgery

Abstract Objective(s): To compare post-operative arterial blood gas samples and requirement for respiratory support between patients who received sugammadex versus neostigmine reversal prior to extubation after congenital cardiac surgery Design: Retrospective, cross-sectional study Setting: Single-center, university-based, tertiary care hospital. Participants: Patients with congenital heart disease undergoing surgery with cardiopulmonary bypass Interventions: Chart review Measurements and Main Results: The first postoperative arterial blood gases were abstracted from electronic medical records, and reintubation or use of positive pressure respiratory support within the first 24 postoperative hours was documented. Of the 237 charts reviewed, 111 (47%) received sugammadex reversal and 126 (53%) received neostigmine. Multivariable models showed patients with two-ventricle congenital heart disease who received sugammadex had lower post-operative PaCO2 (coefficient -3.1, 95% CI -5.9–(-)0.4, p = .026) and required less non-invasive positive pressure ventilation (OR 0.3, 95% CI 0.1–0.8, p = .021). Single-ventricle congenital heart disease patients who received sugammadex had higher post-operative pH (coefficient 0.04, 95% CI 0.01–0.06, p = .01) and lower PaCO2 (coefficient -5.2, 95% CI -9.6–(-)0.8, p = .021). Conclusions: Sugammadex reversal was associated with lower postoperative PaCO2. In addition, sugammadex reversal was associated with less need for non-invasive positive pressure ventilation in two-ventricle patients. The magnitude of the effect appears modest, so the clinical significance remains uncertain. Additional studies focused on investigating particular patient populations, such as infants, single-ventricle congenital heart disease, or those with pulmonary hypertension, are needed to identify if these patients appreciate a greater benefit from sugammadex reversal.