search for


 

Sugammadex use can decrease the incidence of post-operative urinary retention by avoiding anticholinergics: a retrospective study
Anesth Pain Med 2018;13(1):40-6
Published online January 31, 2018
© 2018 The Korean Society of Anesthesiologists.

Jung-Eun Cha1, Sung Wook Park1, Young In Choi1, In Duk Oh1, Hee Yong Kang1, Sang Hyub Lee2, and Jeong-Hyun Choi1
1Department of Anesthesiology and Pain Medicine, Kyung Hee University, Seoul, Korea,
2Department of Urology, College of Medicine, Kyung Hee University, Seoul, Korea
Correspondence to: Jeong-Hyun Choi, M.D., Ph.D. Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Korea Tel: 82-2-958-8589 Fax: 82-2-958-8580 E-mail: choikhang@gmail.com
Received August 7, 2017; Revised September 6, 2017; Accepted September 27, 2017.
cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract

Background:

Postoperative urinary retention (POUR) is a common complication after total knee arthroplasty (TKA) and associated with the use of anticholinergics. The introduction of sugammadex has decreased perioperative use of anticholinergics. Since anticholinergics may influence the detrusor muscle, the purpose of this study was to compare incidence of POUR between sugammadex and anticholinergic use for reversal of muscle relaxant.

Methods:

This study was a retrospective cohort study in a university-affiliated hospital. A total of 571 patients who underwent TKA between 2015 and 2016 with an American Society of Anesthesiologists class ≤ 3 were included in this study. Patients who received sugammadex (group S, n = 208) were compared to those who received glycopyrrolate with pyridostigmine (group C, n = 363) for reversal of neuromuscular blockade. The primary outcome was the incidence of POUR. Secondary outcomes were hospital length of stay (HOS) and daily residual urine drained from intermittent catheterization. Demographic, intraoperative, and laboratory data were collected.

Results:

The incidence of POUR was significantly lower in group S compared to group C (36.1 vs. 48.8%, P = 0.003). On post-operative day (POD) 0, there was no significant difference in the residual urine volume between the two groups. However, from POD 1 to POD 4, the residual urine volume was significantly lower in group S compared to group C. There was no significant difference in HOS between the two groups.

Conclusions:

The use of sugammadex was associated with a lower incidence of POUR by avoiding glycopyrrolate in patients underwent TKA.

Key Words : Arthroplasty, replacement, knee, Cholinergic antagonists, Urinary retention
INTRODUCTION

It is reported that the incidence of post-operative urinary retention (POUR) is about 3.8% in general surgery patients but it is 20 times higher in patients undergoing lower extremity surgery such as total knee arthroplasty (TKA) [1,2]. POUR may lead to bladder tissue damage and urinary tract infection, which can cause joint infection following arthroplasty [35]. Previous studies reported that patient age, diabetes, pre-operative voiding dysfunction, operation time, amounts of intraoperative fluid, perioperative use of opioids and anticholinergics may affect the development of POUR [611].

During general anesthesia, anticholinergics are used to decrease oral secretion, to treat bradycardia, or to antagonize the side effects of anticholinesterase used to reverse neuromuscular block at the end of the surgery. However, anticholinergics have an inhibitory effect on bladder contraction in the presence of outlet obstruction, an effect achieved primarily by antagonizing postjunctional excitatory muscarinic receptors in the detrusor muscle, thereby increasing the frequency of POUR [1,9,12]. Recently, a selective relaxant binding agent, sugammadex, has been introduced into clinical practice. Sugammadex restores muscle relaxation through rapid and strong one-to-one bonding with rocuronium or vecuronium in the plasma, which has no effect on acetylcholinesterase [13,14]. Since sugammadex decreases the use of perioperative anticholinergics, it also may affect the incidence of POUR.

The purpose of this study was to compare the incidence of POUR between patients who received sugammadex and those who received anticholinesterases with anticholinergics for reversal of neuromuscular blockade.

MATERIALS AND METHODS

This study was approved by the Hospital Ethics Committee (No. 2017-07-046). A retrospective cohort study was performed on 812 patients who underwent TKA from January 2015 to December 2016. Twelve patients with benign prostatic hyperplasia, 7 patients with chronic kidney disease stages 3–5, 220 patients who underwent bilateral TKA, and two patients with spinal anesthesia were excluded from this study. A total of 571 patients were included in this study. Patients’ clinical information was collected via electronic medical records. The primary outcome was the incidence of POUR, and the secondary outcomes were hospital length of stay (HOS) and daily urine volume drained from intermittent urinary catheterization. Collected data were the American Society of Anesthesiologists physical status classification, operation/anesthesia time, amounts of administered fluid during surgery, anticholinergic use (pre-treatment with glycopyrrolate 0.2 mg before induction of anesthesia), number of opioids used during and after surgery, pre- and post-operative blood urea nitrogen/creatinine (Cr), and daily urine volume drained from intermittent urinary catheterization.

POUR was defined as a case of urinary retention of more than 400 ml due to self-voiding difficulties until post-operative discharge [15]. In our hospital, the residual urine volume of patients undergoing TKA and who have self-voiding difficulties or complain of a sense of residual urine is routinely assessed with a nelaton catheter until residual urine is less than 100 ml. All patients received 2 mg/kg of propofol and 0.8 mg/kg of rocuronium for induction, and maintenance remifentanil (0.05−0.2 μg/kg/min) was administered. Patient-controlled analgesia (PCA) for postoperative pain control consisted of fentanyl 0.5 μg/kg/h for all patients.

Patients were divided into a sugammadex group (group S, n = 208) or control group (group C, n = 363) according to the reversal agent used to reverse neuromuscular blockade. Patients in group S received sugammadex 2 mg/kg and patients in group C received the combination of glycopyrrolate 0.4 mg (an anticholinergic agent) and pyridostigmine 15 mg (an anticholinesterase agent). The choice of reversal agents was decided by the anesthesiologist depending on preference. In the postanesthesia care unit (PACU), patients with voiding difficulties were treated with intermittent urinary catheterization.

Values were expressed as mean ± standard deviation and number of patients (percent). Comparisons between groups were analyzed with the t-test for continuous variables and χ2 test for categorical data. The relationship between each variable and POUR was analyzed through univariable logistic regression, and multivariable logistic regression was conducted with variables with a P value of 0.05 or less. Statistical analysis was conducted using SPSS 21.0 for Windows (IBM Corp., USA). P values less than 0.05 were considered statistically significant.

RESULTS

Patient characteristics are presented in Table 1. The mean age of patients was statistically higher in group S compared to group C. There was no significant difference in hypertension, diabetes, cerebrovascular disease, hyperlipidemia, and chronic kidney disease between the groups. Compared to group S, the number of patients with cardiovascular disease was significantly lower in group C.

Patients’ Characteristics

 Variable  Group C (n = 363)   Group S (n = 208)   P value 
Age (yr) 69.4 ± 7.0 70.7 ± 6.7 0.033
Sex (male) 29 (8.0) 23 (11.0) 0.220
Height (cm) 154.2 ± 6.4 154.6 ± 7.0 0.507
Weight (kg) 62.1 ± 9.4 62.3 ± 9.1 0.800
Medical history
 Diabetes mellitus 97 (26.7) 64 (30.8) 0.301
 Hypertension 250 (68.9) 138 (66.3) 0.534
 Hyperlipidemia 34 (9.4) 30 (14.4) 0.065
 Cerebrovalcular disease  33 (9.1) 23 (11.1) 0.450
 CKD stage 1 1 (0.3) 2 (1.0) 0.301
 CKD stage 2 0 (0) 1 (0.5) 0.364
 Coronary artery disease 15 (4.1) 21 (10.1) 0.005

Data are expressed as mean ± SD or number (%). Group C: control group used glycopyrrolate with pyridostigmine, Group S: the group used sugammadex, CKD: chronic kidney disease.



Perioperative data are listed in Table 2. Mean duration of surgery was significantly longer in group C than that in group S (P = 0.013) (Table 2). The amount of administered crystalloid fluid was significantly higher but colloid was lower in group C compared to group S (both P < 0.001). The mean Cr levels before and after surgery were within normal limits. There was no difference in the use of anticholinergics for premedication and duration of anesthetic between the groups. There was no difference between the groups in the amount of fentanyl in PCA (Table 2). The amount of oxycodone administered in the PACU was significantly higher in group C compared to group S; however, the amount of fentanyl administered in the PACU was significantly higher in group S than in group C.

Perioperative Data

 Variable  Group C (n = 363)   Group S (n = 208)   P value 
Anesthetic agent used 0.004
 Sevoflurane 204 (56.2) 144 (69.2)
 Desflurane 157 (43.3) 64 (30.8)
 TIVA 2 (0.6) 0 (0)
Anticholinergics premedication  355 (97.8) 204 (98.1) 1.000
Duration of anesthesia (min) 165.1 ± 20.9 162.0 ± 22.0 0.095
Duration of surgery (min) 115.2 ± 18.6 110.5 ± 23.4 0.013
Intraoperative colloid (ml) 20.5 ± 92.9 121.4 ± 276.7 < 0.001
Intraoperative crystalloid (ml) 682.6 ± 215.5 476..0 ± 304.2 < 0.001
Preoperative BUN (mg/dl) 19.0 ± 7.1 23.6 ± 8.6 < 0.001
Postoperative BUN (mg/dl) 29.8 ± 9.5 28.9 ± 8.4 0.263
Preoperative Cr (mg/dl) 0.7 ± 0.2 0.6 ± 0.2 0.001
Postoperative Cr (mg/dl) 0.6 ± 0.2 0.6 ± 0.1 0.008
PCA fentanyl (μg) 808.9 ± 306.3 784.6 ± 208.2 0.261
PACU fentanyl (μg) 24.7 ± 25.6 32.1 ± 29.0 0.002
PACU oxycodone (mg) 0.4 ± 1.1 0.1 ± 0.7 < 0.001
PACU demerol (mg) 0.9 ± 4.7 0.5 ± 3.4 0.225

Data are expressed as number (%) or mean ± SD. Group C: control group used glycopyrrolate with pyridostigmine, Group S: the group used sugammadex, Anticholinergics premedication: glycopyrrolate 0.2 mg before induction, TIVA: total intravenous anesthesia, BUN: blood urea nitrogen, Cr: creatinine, PCA: patient-controlled analgesia, PACU: postanesthesia care unit.



The urinary outcomes are presented in Table 3. The incidence of POUR was significantly lower in group S compared to group C (P = 0.003). There was no difference in the incidence of urinary catheterization between the groups at post-operative day (POD) 0, but this was significantly higher in group C compared to group S from POD 1 to POD 4. Total volume of residual urine was significantly higher in group C compared to group S (P = 0.001) (Table 4). Daily residual urine volume drained from urinary catheterization after surgery revealed no difference between the groups at POD 0, but this was significantly higher in group C than group S from POD 1 to POD 4.

Comparison of Outcomes

 Variable  Group C (n = 363)   Group S (n = 208)   P value 
Incidence of POUR 177 (48.8) 75 (36.1) 0.003
Hospital length of stay (d) 10.9 ± 2.0 10.7 ± 1.7 0.240
Incidence of urinary catheterization 
 POD 0 211 (58.1) 135 (64.9) 0.111
 POD 1 194 (53.4) 82 (39.4) 0.001
 POD 2 116 (32.0) 40 (19.2) 0.001
 POD 3 56 (15.4) 14 (6.7) 0.002
 POD 4 20 (5.5) 4 (1.9) 0.040
 POD 5 11 (3.0) 3 (1.4) 0.238
 POD 6 6 (1.7) 3 (1.4) 1.000
 POD 7 2 (0.6) 2 (1.0) 0.625
 POD 8 1 (0.3) 1 (0.5) 1.000

Data are expressed as number (%) or mean ± SD. Group C: control group used glycopyrrolate with pyridostigmine, Group S: the group used sugammadex, POUR: postoperative urinary retention, POD: post-operative day.


Daily Residual Urine Volume Drained from Urinary Catheterization after Surgery

 Variable  Group C (n = 363)   Group S (n = 208)   P value 
Residual urine volume (ml)
 POD 0 261.8 ± 280.0 276.1 ± 361.1 0.717
 POD 1 527.0 ± 876.3 330.0 ± 544.0 0.001
 POD 2 277.3 ± 541.0 137.0 ± 541.0 < 0.001
 POD 3 96.9 ± 290.1 35.4 ± 157.6 0.001
 POD 4 34.7 ± 176.0 20.0 ± 187.4 0.041
 POD 5 20.5 ± 145.3 12.7 ± 115.3 0.244
 POD 6 14.1 ± 131.5 9.9 ± 97.9 0.846
 POD 7 4.1 ± 55.7 7.2 ± 75.9 0.572
 POD 8 1.9 ± 36.7 1.2 ± 17.3 0.692
Total residual urine volume (ml)  1,238.3 ± 1,733.6 829.3 ± 1,204.1 0.001

Data are expressed as mean ± SD. Group C: control group used glycopyrrolate with pyridostigmine, Group S: the group used sugammadex, POD: post-operative day, Total residual urine volume: total mean residual urine volume drained from urinary catheterization from postoperative day 0 to 8.



Univariable logistic regression analysis revealed that the incidence of POUR in group S was 0.59 times lower than that in group C (odds ratio, 0.59; 95% CI, 0.42–0.84; P = 0.003) (Table 5). Univariable logistic regression analysis revealed that increased age, male sex, diabetes mellitus, cerebrovascular disease, American Society of Anesthesiologists physical status classification 3, and the amount of intra-operative crystalloid increased the risk of POUR. On the other hand, desflurane anesthesia and the use of sugammadex reduced the incidence of POUR (Table 5). In multivariate logistic regression analysis, all variables except diabetes and American Society of Anesthesiologists physical status classification were consistently significant (Table 6).

Univariable Logistic Regression of POUR

 Variable POUR  P value  Odds ratio (95% CI) P value
 Yes (n = 252)   No (n = 319) 
Age (yr) 70.8 ± 6.3 69.1 ± 7.2 0.016
Sex (male) 32 (12.7) 20 (6.3) 0.008 2.18 (1.21–3.90) 0.009
ASA
 1 2 (0.8) 7 (2.2) 0.023 Reference
 2 226 (89.7) 298 (93.4) 2.65 (0.55–12.90) 0.226
 3 24 (9.5) 14 (4.4) 6.00 (1.09–32.98) 0.039
Hypertension 178 (70.6) 210 (65.8) 0.222 1.25 (0.87–1.78) 0.222
Diabetes mellitus 83 (32.9) 78 (24.5) 0.025 1.52 (1.05–2.19) 0.026
Hyperlipidemia 35 (13.9) 29 (9.1) 0.071 1.61 (0.96–2.72) 0.073
Cerebral vascular disease 35 (13.9) 21 (6.6) 0.004 2.29 (1.30–4.04) 0.004
CKD
 Stage 1 2 (0.8) 1 (0.3) 0.586 2.54 (0.23–28.22) 0.447
 Stage 2 0 (0) 1 (0.3) 1.000 < 0.001 (< 0.001, > 999.99) 0.986
Coronary artery disease 12 (4.8) 24 (7.5) 0.178 0.62 (0.30–1.26) 0.181
Intraoperative colloids (ml) 59.7 ± 206.7 55.3 ± 173.8 0.994 1.00 (1.00) 0.782
Intraoperative crystalloids (ml)  633.5 ± 272.7 586.7 ± 266.6 0.007 1.00 (1.00) 0.041
Sugammadex 75 (29.8) 133 (41.7) 0.003 0.59 (0.42–0.84) 0.003
Anesthesia
 Sevoflurane 178 (70.6) 170 (53.3) 0.001 Reference
 Desflurane 73 (29.0) 148 (46.4) 0.47 (0.33–0.67) < 0.001
 TIVA 1 (0.4) 1 (0.3) 0.96 (0.06–15.39) 0.974

Data are expressed as mean ± SD or number (%). POUR: postoperative urinary retention, ASA: American Society of Anesthesiologists physical status classification, CKD: chronic kidney disease, TIVA: total intravenous anesthesia.


Multivariable Logistic Regression of POUR

 Variable  Odds ratio (95% confidence interval)   P value 
Sugammadex  0.50 (0.34–0.75) 0.001
Age (yr) 1.04 (1.01–1.06) 0.009
Sex (male) 2.09 (1.13–3.87) 0.018
DM 1.40 (0.95–2.07) 0.089
CVA 1.86 (1.01–3.42) 0.045
ASA 3 1.78 (0.91–3.49) 0.093
Crystalloids 1.00 (1.00) 0.297
Desflurane 0.48 (0.34–0.70) < 0.001

POUR: postoperative urinary retention, DM: diabetes mellitus, CVA: cerebrovascular accident, ASA: American Society of Anesthesiologists physical status classification, Crystalloids: amounts of crystalloid administered during surgery.


DISCUSSION

Compared to conventional reversal agents combined with glycopyrrolate, the incidence of POUR was lower when sugammadex was used for reversal of neuromuscular blockade in patients undergoing TKA. From POD 1 to POD 4, the incidence of urinary catheterization was also lower in patients received with sugammadex compared to those that received conventional reversal agents.

As mentioned above, it is reported that the incidence of POUR is 20 times higher in patients undergoing lower extremity surgery such as TKA compared to general surgery patients (3.8%) [1,2]. In this study, the total incidence of POUR after TKA was 44%. The definition of POUR varies according to researchers. Pavlin et al. [15] reported that urinary retention is an inability to void despite a bladder volume of more than 400 ml. Balderi and Carli [16] defined POUR as a bladder volume of more than 600 ml after self-voiding as measured by ultrasound. Lee et al. [6] defined POUR as the inability to urinate or a residual urine volume of more than 100 ml after self-voiding for two days after surgery. It has been reported that a normal bladder volume is 400–600 ml in healthy adults and that individuals begin to feel the sense of voiding at a bladder volume of 150 ml [17]. When bladder volume reaches 300 ml, patients feel a sense of urinary urgency. If patients do not feel a voiding sense despite bladder volume of more than 300 ml, there is a voiding problem. In this study, the POUR was defined according to the study by Pavlin et al. [15].

POUR is associated with multiple factors which interact with each other. A previous study described age 50 years or older, more than 750 ml of intraoperative fluid, and bladder volume more than 270 ml on arrival in PACU as predictive factors of POUR [18]. Another study reported that elderly and lengthy operation time were significant risk factors for POUR [6]. The effect of morphine on the lower urinary tract is complex. Morphine tightens the detrusor muscle and urethral sphincter by inhibiting the release of acetylcholine and makes the bladder distension unrecognizable by acting on the central nervous system [19].

Anticholinesterases, which increase the amount of acetylcholine, are used for reversal of neuromuscular blockade at the end of general anesthesia. Increased acetylcholine molecules act not only on the nicotinic receptor but also on the muscarinic receptor, resulting in a parasympathetic dominance effect, which manifests as bradycardia, bronchial contraction, and vomiting. Furthermore, increased acetylcholine released from parasympathetic fibers causes contraction of the detrusor muscle and relaxation of the neck, permitting micturition [20]. Anticholinergics such as atropine and glycopyrrolate used to prevent the muscarinic effect of anticholinesterases can block detrusor contractions and cause bladder hypotonia, resulting in urinary retention [9]. On the other hand, sugammadex reverses neuromuscular blockade by selectively binding with a steroidal non-depolarizing neuromuscular blocking agent [12]. In this study, the incidence of POUR and daily residual urine volume from POD 1 to POD 4 were significantly lower in the sugammadex group. Results are likely due to the avoidance of glycopyrrolate. A potential explanation for the delayed recovery of POUR until POD 4 despite the half-life of glycopyrrolate being 1.7 hours may be age-related progressive neuronal degeneration because relatively elderly patients (mean age of about 70 years) were included in this study [20].

In this study, the amount of intra-operative crystalloid administered was significantly higher in the control group than the sugammadex group (P < 0.001). This is consistent with the results of a previous study reporting that the incidence of POUR increases as the amount of intra-operative crystalloid increases [18]. However, the amount of colloid administered was not associated with the incidence of POUR.

In univariable logistic regression analysis, the probability of POUR was increased to 1.52 in diabetic patients (P = 0.026). Decrease in bladder function due to diabetic neuropathy may have affected this result. The incidence of POUR was significantly higher in patients with cerebrovascular disease, with an odds ratio of 2.29 (P = 0.004). Although more research is needed, it is thought that urination is coordinated by neurons of the pontine-mesencephalic gray matter and pontine micturition center, and this neuronal pathway may have an effect on POUR if accompanied by cerebrovascular disease [21]. Interestingly, when desflurane was used as an inhalation agent, the incidence of POUR was reduced. However, desflurane activates the sympathetic nervous system during inhalation at a high concentration, which is contradictory to results of this study. Further studies are needed to consider the effect of various anesthetic agents on POUR.

There was no difference in the dose of fentanyl used in the PCA between the groups, but the amount of opioids used in the PACU varied according to the type of opioids. Opioids may affect urinary retention through changes in parasympathetic tone and decreased pain threshold in the bladder [19,22]. Several studies have revealed that opioids are associated with the occurrence of POUR [10,23]. However, the difference in the amount of opioid used in the PACU in this study was due to the analgesic choice of the anesthesiologist.

Limitations of this study are as follows. First, this study was a retrospective study and did not completely exclude the influence of confounding variables. The types of opioids used in PACU and the types of fluid used during the operation were not consistent. Second, the definition of POUR is not fully established. Although the criteria used to define POUR relied on previously published studies, the definition used in this study did not strictly diagnose POUR. Third, since the study was conducted by one institution, the guideline of voiding management of our institute may have affected the outcome of POUR.

Nevertheless, the results of this study demonstrate that the use of sugammadex was associated with a lower incidence of POUR by avoiding glycopyrrolate in patients that underwent TKA.

ACKNOWLEDGMENTS

The authors want to thank our residents who provided help in collecting data.

References
  1. Mier RJ, Bachrach SJ, Lakin RC, Barker T, Childs J, and Moran M. Treatment of sialorrhea with glycopyrrolate: a double-blind, dose-ranging study. Arch Pediatr Adolesc Med 2000;154:1214-8.
    Pubmed CrossRef
  2. Tammela T, Kontturi M, and Lukkarinen O. Postoperative urinary retention. I. Incidence and predisposing factors. Scand J Urol Nephrol 1986;20:197-201.
    Pubmed CrossRef
  3. Brouwer TA, Eindhoven BG, Epema AH, and Henning RH. Validation of an ultrasound scanner for determing urinary volumes in surgical patients and volunteers. J Clin Monit Comput 1999;15:379-85.
    Pubmed CrossRef
  4. Kumar P, Mannan K, Chowdhury AM, Kong KC, and Pati J. Urinary retention and the role of indwelling catheterization following total knee arthroplasty. Int Braz J Urol 2006;32:31-4.
    Pubmed CrossRef
  5. Irvine R, Johnson BL, and Amstutz HC. The relationship of genitourinary tract procedures and deep sepsis after total hip replacements. Surg Gynecol Obstet 1974;139:701-6.
    Pubmed
  6. Lee S, Kim CH, Chung CK, Park SB, Yang SH, and Kim SH et al. Risk factor analysis for postoperative urinary retention after surgery for degenerative lumbar spinal stenosis. Spine J 2017;17:469-77.
    Pubmed CrossRef
  7. Lau H, and Lam B. Management of postoperative urinary retention: a randomized trial of in-out versus overnight catheterization. ANZ J Surg 2004;74:658-61.
    Pubmed CrossRef
  8. Toyonaga T, Matsushima M, Sogawa N, Jiang SF, Matsumura N, and Shimojima Y et al. Postoperative urinary retention after surgery for benign anorectal disease: potential risk factors and strategy for prevention. Int J Colorectal Dis 2006;21:676-82.
    Pubmed CrossRef
  9. Verhamme KM, Sturkenboom MC, Stricker BH, and Bosch R. Drug-induced urinary retention: incidence, management and prevention. Drug Saf 2008;31:373-88.
    Pubmed CrossRef
  10. Petros JG, Rimm EB, and Robillard RJ. Factors influencing urinary tract retention after elective open cholecystectomy. Surg Gynecol Obstet 1992;174:497-500.
    Pubmed
  11. Petros JG, Mallen JK, Howe K, Rimm EB, and Robillard RJ. Patient-controlled analgesia and postoperative urinary retention after open appendectomy. Surg Gynecol Obstet 1993;177:172-5.
    Pubmed
  12. Welliver M, McDonough J, Kalynych N, and Redfern R. Discovery, development, and clinical application of sugammadex sodium, a selective relaxant binding agent. Drug Des Devel Ther 2009;2:49-59.
    Pubmed KoreaMed
  13. Naguib M. Sugammadex: another milestone in clinical neuromuscular pharmacology. Anesth Analg 2007;104:575-81.
    Pubmed CrossRef
  14. Lee S. What anesthesiologists ask to know and should know about the neuromuscular monitoring: an updated review. Anesth Pain Med 2017;12:1-8.
    CrossRef
  15. Pavlin DJ, Pavlin EG, Gunn HC, Taraday JK, and Koerschgen ME. Voiding in patients managed with or without ultrasound monitoring of bladder volume after outpatient surgery. Anesth Analg 1999;89:90-7.
    Pubmed CrossRef
  16. Balderi T, and Carli F. Urinary retention after total hip and knee arthroplasty. Minerva Anestesiol 2010;76:120-30.
    Pubmed
  17. Lamonerie L, Marret E, Deleuze A, Lembert N, Dupont M, and Bonnet F. Prevalence of postoperative bladder distension and urinary retention detected by ultrasound measurement. Br J Anaesth 2004;92:544-6.
    Pubmed CrossRef
  18. Keita H, Diouf E, Tubach F, Brouwer T, Dahmani S, and Mantz J et al. Predictive factors of early postoperative urinary retention in the postanesthesia care unit. Anesth Analg 2005;101:592-6. table of contents
    Pubmed CrossRef
  19. Husted S, Djurhuus JC, Husegaard HC, Jepsen J, and Mortensen J. Effect of postoperative extradural morphine on lower urinary tract function. Acta Anaesthesiol Scand 1985;29:183-5.
    Pubmed CrossRef
  20. Baldini G, Bagry H, Aprikian A, and Carli F. Postoperative urinary retention: anesthetic and perioperative considerations. Anesthesiology 2009;110:1139-57.
    Pubmed CrossRef
  21. Marinkovic SP, and Badlani G. Voiding and sexual dysfunction after cerebrovascular accidents. J Urol 2001;165:359-70.
    CrossRef
  22. Malinovsky JM, Le Normand L, Lepage JY, Malinge M, Cozian A, and Pinaud M et al. The urodynamic effects of intravenous opioids and ketoprofen in humans. Anesth Analg 1998;87:456-61.
    Pubmed CrossRef
  23. Stallard S, and Prescott S. Postoperative urinary retention in general surgical patients. Br J Surg 1988;75:1141-3.
    Pubmed CrossRef


July 2018, 13 (3)
Full Text(PDF) Free

Social Network Service
Services

Cited By Articles
  • CrossRef (0)