Evidence map›Paper›PMID 36675492›Full record

ArticleJournal of clinical medicine2023

REVersal of nEuromusculAr bLocking Agents in Patients Undergoing General Anaesthesia (REVEAL Study).

Massimiliano Greco, Pier Francesco Caruso, Giovanni Angelotti, Romina Aceto, Giacomo Coppalini, Nicolò Martinetti, Marco Albini, Lori D Bash, Michele Carvello, Federico Piccioni and 3 more

Open access · goldAbstract read
In one paragraph

Article in Journal of clinical medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
0.3field-weighted citation impact, top 44% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 citations in OpenAlex.

  1. Review
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors at 3 institutions in 2 countries.

Massimiliano GrecoDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy.ORCID 0000-0003-1003-4637
Pier Francesco CarusoDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy.ORCID 0000-0002-0839-4396
Giovanni AngelottiIRCCS Humanitas Research Hospital, 20089 Milan, Italy.
Romina AcetoDepartment of Anaesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, 20089 Milan, Italy.
Giacomo CoppaliniDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy.
Nicolò MartinettiDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy.ORCID 0000-0002-5273-1660
Marco AlbiniIRCCS Humanitas Research Hospital, 20089 Milan, Italy.
Lori D BashMerck & Co., Inc., Rahway, NJ 07065, USA.
Michele CarvelloDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy.
Federico PiccioniDepartment of Anaesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, 20089 Milan, Italy.ORCID 0000-0002-9589-1891
Roberta MonzaniDepartment of Anaesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, 20089 Milan, Italy.ORCID 0000-0002-8861-0801
Marco MontorsiDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy.
Maurizio CecconiDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy.
Humanitas University · ITIRCCS Humanitas Research Hospital · ITMerck & Co., Inc., Rahway, NJ, USA (United States) · US

Funding

Merck Sharp & Dohme Corp CORE initiative, Center for Observational and Real-world Evidence (CORE)
6 · The paper itself

Abstract

Background: Neuromuscular blocking agent (NMBA) monitoring and reversals are key to avoiding residual curarization and improving patient outcomes. Sugammadex is a NMBA reversal with favorable pharmacological properties. There is a lack of real-world data detailing how the diffusion of sugammadex affects anesthetic monitoring and practice. Methods: We conducted an electronic health record analysis study, including all adult surgical patients undergoing general anesthesia with orotracheal intubation, from January 2016 to December 2019, to describe changes and temporal trends of NMBAs and NMBA reversals administration. Results: From an initial population of 115,046 surgeries, we included 37,882 procedures, with 24,583 (64.9%) treated with spontaneous recovery from neuromuscular block and 13,299 (35.1%) with NMBA reversals. NMBA reversals use doubled over 4 years from 25.5% to 42.5%, mainly driven by sugammadex use, which increased from 17.8% to 38.3%. Rocuronium increased from 58.6% (2016) to 94.5% (2019). Factors associated with NMBA reversal use in the multivariable analysis were severe obesity (OR 3.33 for class II and OR 11.4 for class III obesity, p-value < 0.001), and high ASA score (OR 1.47 for ASA III). Among comorbidities, OSAS, asthma, and other respiratory diseases showed the strongest association with NMBA reversal administration. Conclusions: Unrestricted availability of sugammadex led to a considerable increase in pharmacological NMBA reversal, with rocuronium use also rising. More research is needed to determine how unrestricted and safer NMBA reversal affects anesthesia intraoperative monitoring and practice.

Indexed as

anesthesianeuromuscular blocking agentsNMBAresidual curarizationrocuroniumsugammadexsurgery

Identifiers

PMID36675492
PMCPMC9866312
OpenAlexW4315647968

What OpenQuestion holds

Textmetadata
LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.