Post-Operative Endotracheal Reintubation Rates

Immediate post-operative endotracheal reintubation after major abdominal surgery a significant patient safety concern due to the potential for failure to rescue, or other adverse outcomes such as altered mental status, aspiration, and hypoxia due to respiratory or cardiac arrest if left unrecognized. To facilitate major abdominal surgery (outside of a cesarean section performed under spinal anesthesia), the patient must be anesthetized, pharmacologically paralyzed, and endotracheally intubated to facilitate ventilation via mechanical respiration. Those steps create the optimal environment to allow the abdominal muscles to relax, and permits the surgeon obtain appropriate exposure of the abdominal cavity. An induced chemical paralysis is commonly achieved by a medication named rocuronium, which is an intermediate-acting neuromuscular blocking medication, which is one of the most frequently used paralytic medications used in clinical practice for surgical patients. When the abdomen is closed and surgery is complete, the usual course of action is to pharmacologically reverse the muscle relaxant, stop anesthesia, endotracheally extubate, and awaken the patient so that he or she can be transferred to the post-anesthesia care unit (PACU, also known as the recovery room), or less commonly remain sedated and intubated for the PACU or intensive care unit.The standard of practice in the Unites States is to provide a reversal agent for the neuromuscular relaxant. Muscle relaxants are also known as paralytic medications or neuromuscular blocking agents (NMBAs). The purpose of this project is to assess the safest and most efficient reversal agent for avoiding endotracheal reintubation in the PACU. Surgical laparotomy patients were chosen because it is well known that patients with open abdominal surgery are already at risk for post-operative hypoventilation due to surgical pain and associated co-morbidities. PICOT question: Do adult surgical patients undergoing laparotomy procedures who received rocuronium and are reversed with sugammadex as compared with neostigmine require endotracheal reintubation prior to post-anesthesia care unit (PACU) discharge at similar rates?