Professor Kate Leslie AO FAHMS
The SNaPP Study: Sugammadex, Neostigmine and Postoperative Pulmonary Complication
Postoperative pulmonary complications are among the most common, serious and costly complications of surgery and anaesthesia. Residual neuromuscular blockade after inadequate reversal of neuromuscular blocking drugs is a well-described risk factor for postoperative pulmonary complications.
Sugammadex – a novel cyclodextrin reversal agent – reduces the incidence of residual neuromuscular blockade compared with neostigmine and was associated with fewer postoperative pulmonary complications in observational studies. However definitive evidence from randomised trials is lacking. Furthermore, sugammadex is considerably more expensive than neostigmine and causes more anaphylaxis.
This multicentre, comparative effectiveness trial will compare the incidence of death and new pulmonary complications up to hospital discharge (or postoperative day 7 if still in hospital) in patients aged 40 years and over having abdominal or thoracic surgery who are randomised to sugammadex or neostigmine for reversing neuromuscular blockade. All other aspects of perioperative care will be at the discretion of the treating team.
Secondary aims include to compare incidences of postoperative nausea and vomiting in the two groups; record safety outcomes; conduct a cost effectiveness analysis based on quality of life at 3 months; and explore associations between frailty and postoperative pulmonary complications.
We will enrol 3,500 patients at sites affiliated with the Australian and New Zealand College of Anaesthetists Clinical Trials Network. This large pragmatic study has the potential to change practice immediately and improve outcomes for millions of patients and health services worldwide.
Professor Kate Leslie, Department of Critical Care, University of Melbourne
Professor David Story, Department of Critical Care, University of Melbourne
Associate Professor Jai Darvall, Department of Critical Care, University of Melbourne
Professor Philip Peyton, Department of Critical Care, University of Melbourne
Miss Sabine Braat, School of Population and Global Health, University of Melbourne
Professor Nancy Delvin, University of Melbourne
Professor Paul Myles, Monash University
Professor Tomas Corcoran, Royal Perth Hospital
Professor Timothy Short, Auckland Hospital
Professor Matthew Chan, Chinese University of Hong Kong
Dr Benjamin Olesnicky, Royal North Shore Hospital
Dr An Tran-Duy, University of Melbourne
Helen Maxwell- Wright
Cindy Schultz Ferguson
Sofia Sidiropoulos (Trial Manager)
Bhavita Patel (Trial Coordinator)
Vi Ha (Trial Coordinator)
Australian and New Zealand College of Anaesthetists & Faculty of Pain Medicine
Leslie, K., Chan, M. T. V., Darvall, J. N., De Silva, A. P., Braat, S., Devlin, N. J., Peyton, P. J., Radnor, J., Lam, C. K. M., Sidiropoulos, S., & Story, D. A. (2021). Sugammadex, neostigmine and postoperative pulmonary complications: an international randomised feasibility and pilot trial. Pilot and Feasibility Studies, 7(1), 200. doi.org/10.1186/s40814-021-00942-9
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