Optimizing recovery in orthognathic surgery: the cohort study of impact of rocuronium–sugammadex on extubation and perioperative outcomes

Background: Orthognathic surgery (OGS) often necessitates deep neuromuscular blockade to optimize surgical conditions, but the choice of neuromuscular blocking and reversal agents may influence postoperative recovery. Rocuronium, when reversed with sugammadex, offers rapid neuromuscular recovery compared to traditional cisatracurium and neostigmine. This study evaluates the impact of rocuronium/sugammadex versus cisatracurium/neostigmine on perioperative outcomes in OGS. Methods: This retrospective cohort study analyzed 361 patients who underwent OGS between 2019 and 2022. Patients received either cisatracurium with neostigmine (n = 284) or rocuronium with sugammadex (n = 77). The primary outcome was extubation time. Secondary outcomes included hospital length of stay, intraoperative blood loss, anesthetic consumption, opioid requirements, and hemodynamic stability. Multiple logistic regression identified predictors of delayed extubation. Results: Patients in the rocuronium/sugammadex group demonstrated significantly shorter extubation times (25.0 [15.0–77.5] vs. 55.0 [25.0–85.0] min, p = 0.002) and reduced hospital stays (3 [3–5] vs. 4 [4–5] days, p = 0.003). They also exhibited lower inhalational anesthetic consumption (p = 0.002), reduced surgical blood loss (p = 0.046), and shorter hypotension duration (p = 0.017), albeit with increased intraoperative opioid requirements (p < 0.001). Logistic regression identified sugammadex use as an independent protective factor against delayed extubation (OR = 0.26, 95% CI: 0.13–0.50, p < 0.001). Conclusions: The use of rocuronium with sugammadex in OGS is associated with enhanced postoperative recovery, including reduced extubation time, decreased intraoperative blood loss, and shorter hospital stay.