Neostigmine versus sugammadex on outpatient recovery among obese patients with obstructive sleep apnea: A randomized controlled trial

Patients presenting for outpatient surgery may have several comorbidities, including obesity and obstructive sleep apnea. The objective was to measure the efficacy of sugammadex (versus neostigmine) in reducing post-anesthesia care unit length of stay among obese patients with obstructive sleep apnea undergoing outpatient surgery. Furthermore, we aimed to assess differences in post- and pre-operative pulmonary function test and arterial blood gas metrics. We hypothesized that sugammadex would improve recovery times. This was a single institution randomized controlled double-masked clinical trial assessing the efficacy of sugammadex versus neostigmine in reducing length of stay among obese patients with obstructive sleep apnea undergoing outpatient surgery. Secondary outcomes included changes in pulmonary function test and arterial blood gas measurements postoperatively. Mann Whitney U test was the primary statistic used to compare primary and secondary outcomes. There were 90 subjects enrolled, divided equally into the neostigmine and sugammadex cohorts. The median [quartile] length of stay was 125 min [73, 186] versus 123 min [94, 169] in the neostigmine and sugammadex cohorts, respectively (P = 0.79). There were no statistically significant differences in proportional changes of pulmonary function tests (all P > 0.05) nor arterial blood gas measurements (all P > 0.05). This suggests that among patients with obesity and OSA undergoing low-to-moderate risk surgery in the outpatient setting, routine use of one reversal agent over the other would not affect overall PACU efficiency in an ambulatory surgery center. Trial registration: Clinicaltrials.gov NCT04570150, Principal investigator: Jerry Ingrande, Date of registration: 29/09/2020).