Impact of neoadjuvant chemotherapy on the efficacy of sugammadex for neuromuscular block reversal in ovarian cancer patients: A prospective cohort study.

STUDY OBJECTIVE: To investigate the impact of neoadjuvant chemotherapy (NAC) on the efficacy of sugammadex for neuromuscular block reversal in ovarian cancer patients.

DESIGN: This is a prospective cohort study.

SETTING: Operating room, post-anesthesia care unit (PACU), and wards of a university-affiliated teaching hospital.

PATIENTS: Among the 43 patients who underwent cytoreductive surgery, 21 patients received 3 to 6 cycles of NAC with paclitaxel and carboplatin and were classified as the "Chemo group", while 22 patients did not receive NAC before surgery and were classified as the "Non-chemo group".

INTERVENTION: During the surgery, intermittent injections of rocuronium were given based on the quantitative monitoring results of neuromuscular block. After the surgery, the patient was transferred to the PACU. Upon the reappearance of the second twitch response in train-of-four stimulation (T2), both Chemo group and Non-chemo group were given an intravenous dose of 2 mg/kg of sugammadex to reverse the rocuronium-induced neuromuscular block.

MEASUREMENTS: The primary outcome of the study is the time from sugammadex administration to train-of-four ratio (TOFr) ≥ 0.9. The secondary outcomes include: onset time, clinical duration, recovery index, extubation time, duration of PACU stay, the average dosage of rocuronium.

MAIN RESULTS: After the administration of sugammadex, the time to TOFr ≥0.9 was longer in Chemo group compared to Non-chemo group(5.87 ± 2.20 vs 3.22 ± 1.34 min, p < 0.001). The recovery index [2.25 (1.38, 3.00) vs 1.38 (0.75, 2.06) min, p = 0.020] and extubation time [7.50 (5.34, 10.22) vs 4.45 (4.83, 6.61) min, p = 0.002] were also longer in Chemo group. In the Chemo group, the onset time [2.5 (2.0, 4.75) vs 1.75 (1.44, 2.31) min, p = 0.001] was prolonged, the clinical duration [(39.29 ± 10.29 vs 46.23 ± 5.91 min, p = 0.011)] was shortened, and the average dosage of rocuronium (10.35 ± 2.27 vs 8.51 ± 0.69 μg·kg-1·min-1, P = 0.002) was increased compared to Non-chemo group. There was no significant difference in the duration of PACU stay between the two groups.

CONCLUSION: The study indicated that in patients who underwent NAC, the time from sugammadex administration to TOFr ≥0.9, the recovery index, and the extubation time were prolonged. Additionally, these patients experienced an textended onset time, a shortened clinical duration, and an increased average dosage of rocuronium.