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ORIGINAL ARTICLE
Year : 2017  |  Volume : 4  |  Issue : 3  |  Page : 143-148

Efficacy of sugammadex compared with neostigmine for reversal of rocuronium-induced neuromuscular blockade and deep extubation in outpatient surgeries for asthmatic pediatric patients


Anaesthesia and Intensive Care Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt

Correspondence Address:
Eslam N Nada
Flat 702, El Hedaya Tower 1, Moahada Street, El Sharkia, Zagazig 44519
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/roaic.roaic_112_16

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Background Bronchial asthma in children is considered a challenge for the anesthesiologist because of the perioperative adverse effects, especially the risk for bronchospasm either during induction or more commonly during recovery and extubation. Therefore, the goal should be to minimize this risk by avoiding any triggering stimulus and deep extubation with adequate recovery from the neuromuscular blocker to have full control of pharyngeal and respiratory muscles. The aim of this study was to compare the efficacy of sugammadex with neostigmine on reversing rocuronium-induced neuromuscular blockade (NMB) in asthmatic pediatric patients undergoing outpatient surgical procedures. Patients and methods This prospective randomized study was conducted on 60 patients, aged 3–12 years, with history of bronchial asthma, and scheduled for outpatient lower abdominal or urogenital surgeries. NMB was achieved by administration of rocuronium 0.6 mg/kg and monitorized subjectively with train-of-four mode of peripheral nerve stimulator. Patients were randomly allocated into two groups by using the sealed-envelope method: group N (n=30), which received 0.04 mg/kg neostigmine, and group S (n=30), which received 2 mg/kg sugammadex for reversal of rocuronium-induced NMB. Duration of surgery, time from injection of the reversal agent to the time of extubation (time to extubation), total doses of rocuronium, and time from extubation to recovery were recorded. Any complications such as hemodynamic abnormalities, retching, vomiting, bucking, bronchospasm, laryngospasm, coughing, need for reintubation, or any other complications were recorded. Results There was no significant difference between the two groups as regards age, sex, weight, duration of surgery, and total doses of rocuronium. On the other hand, there was statistically significant difference between the two groups regarding time of NMB reversal to time of extubation: 13.43±4.92 min in the neostigmine group versus 1.84±0.66 min in the sugammadex group (P<0.0001). Moreover, there was statistically significant difference between the two groups regarding time from extubation till time of recovery: 21±5.72 min in group N versus 25.57±5.72 min in group S (P=0.019). Regarding complications, need for succinylcholine, and need for reintubation, although their incidence was higher in the neostigmine group, there was no statistically significant difference between the two groups. Conclusion It was concluded that reversal of rocuronium-induced NMB by using sugammadex was more rapid and safer when compared with neostigmine in asthmatic pediatric patients undergoing outpatient lower abdominal or urogenital surgeries.


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