Researcher want to compare and evaluate the effect of sugammadex on postoperative recovery, with a focus on the occurrence of postoperative urinary dysfunction, in patients who have undergone regular abdominal surgery within a year of being infected with and treated for COVID-19. Post COVID-19 condition is a new and poorly understood clinical syndrome with potentially significant and life-altering consequences. Recent studies suggest that patients who have recovered from COVID-19 may experience autonomic dysfunction and be at risk for autonomic dysregulation/syndrome. In most patients undergoing general anesthesia, neuromuscular blockers are used, and their residual effects delay the recovery of autonomic function after surgery, leading to problems such as worsening bladder and bowel function. Therefore, reversal agents are used to aid in postoperative muscle recovery, with sugammadex and neostigmine being commonly used in clinical practice. While sugammadex is generally expected to result in faster postoperative recovery, limited reports exist on its effectiveness in patients who have recovered from COVID-19. This study aims to verify whether sugammadex is more effective than neostigmine in aiding the recovery of bowel and pulmonary function after surgery in patients who have recovered from COVID-19.
The COVID-19 has had a huge impact on the world, infected tens of millions and killed
hundreds of thousands, and has become a threat to humanity's medical defense system. COVID-19
was understood as an acute infection among infections, and it was expected that there would
be little or no other risk if the acute symptoms were treated. Contrary to our expectations,
however, patients with a history of infection with the coronavirus have reported patients
with sequelae lasting for more than several months. The symptoms shown by these patients were
not limited to some tissues and organs, but were distributed in various ways throughout our
body. These symptoms were defined as 'long COVID'. In particular, among the symptoms of long
COVID patients, there were patients who were diagnosed with orthostatic hypotension,
vasovagal syncope, and orthostatic tachycardia syndrome from symptoms such as palpitations,
shortness of breath, and chest pain. What these diseases have in common is that they are
autonomic nervous system diseases. Therefore, it can be assumed that long COVID patients have
damage to the function of the autonomic nervous system due to past infections, and many
studies have been conducted on this.
The main components of general anesthesia are known to be unconsciousness, muscle relaxation,
analgesia, and reflex suppression. Among these, the reasons why muscle relaxation is
necessary in general anesthesia include ease of intubation and suppression of unnecessary
patient movements during surgery to create a suitable environment for surgery. For muscle
relaxation, anesthesiologists administer neuromuscular relaxants, mainly non-depolarizing
muscle relaxants. Neuromuscular relaxants have the role of inhibiting neurotransmission by
acting on the motor nerve endings of skeletal muscles, because they act on nicotinic
cholinergic receptors in motor nerve endings. However, neuromuscular relaxants also act on
muscarinic cholinergic receptors to inhibit neurotransmission. Since these muscarinic
cholinergic receptors are distributed in the parasympathetic nerves of the autonomic nervous
system, neuromuscular relaxants also inhibit the autonomic nerve system controlled by the
parasympathetic nerves.
Since neuromuscular relaxants are eliminated from the body by pharmacokinetics, the function
of the autonomic nervous system, which has been suppressed by using neuromuscular relaxants,
gradually recovers over time. However, if the action of a neuromuscular relaxant remains
after surgery, the patient will experience autonomic dysfunction even after surgery, which
causes considerable discomfort to the patient. Among them, the symptoms of autonomic
dysfunction related to the parasympathetic nerve that patients mainly feel are related to the
bladder and bowel. Therefore, after the surgery, the anesthesiologist performs the process of
reversing the action of the neuromuscular relaxant when ending general anesthesia, which
makes it possible to expect the recovery of the patient's autonomic nervous system function.
There are two main mechanisms of the drugs used for reversal of nondepolarizing neuromuscular
relaxants. First, there is a drug that inhibits the action of the neuromuscular relaxant by
directly attaching to the neuromuscular relaxant, and second, there is a drug that
competitively inhibits the neuromuscular relaxant by increasing the amount of ach in the
neuromuscular junction. In the meantime, many studies have shown that a drug with the former
mechanism (sugammadex) is superior to the latter drug (typically neostigmine) in the recovery
of patients after surgery. However, there is a lack of research on whether the same research
results will be shown in long COVID patients who have caused damage to the autonomic nervous
system.
Therefore, in this study, sugammadex and neostigmine as described above are divided and
administered to approximately 300 long COVID patients in a double-blind manner, and the
degree of urinary retention is compared to prove that sugammadex is superior to neostigmine
in postoperative recovery even for long COVID patients.
Drug: Sugammadex Sodium
Sugammadex Sodium 2mg/kg when TOF >= 2, postoperative period
Other Name: Bridion
Drug: neostigmine 50µg/kg + glycopyrollate 0.01mg/kg
neostigmine 50µg/kg + glycopyrollate 0.01mg/kg when TOF >= 2, postoperative period
Other Name: neostigmine
Inclusion Criteria:
- Ages between 19 and 70 Male and Female All ethnicity Patients who are scheduled to
take non-emergency abdominal surgery under general anesthesia.
Patients who had the diagnosis of covid-19 by PCR, hospitalized, and applied O2 supplement
therapy.
ASA classification ≤ 3 Patients who had Covid-19 PCR positive within 1 year Patients who
had hospitalized by Covid-19, followed by O2 therapy (nasal prong, continuous positive
airway pressure (CPAP), ventilator etc.) Patients who hospitalized more than 48 hours after
surgery. Patients who had a surgery for more than 1 hour.
Exclusion Criteria:
- Not meeting inclusion criteria Declined to participate Active Covid-19 patients with
PCR positive. Patients are under 19 or over 70 years old
Not Provided
Too Jae Min, M.D., Ph.D.
82-10-7296-0353
minware2@nate.com
Sang Min Yoon, M.D.
82-10-8805-8619
ekha00041@naver.com
Too Jae Min, M.D., Ph.D., Study Chair
Korea University Ansan Hospital