Can sugammadex improve the reversal profile of atracurium under sevoflurane anesthesia?

The current prospective comparative study aimed at the clinical outcome of sugammadex reversal of neuromuscular blockade (NMB) and the evaluation of its impact on the frequency of critical respiratory events during sevoflurane anesthesia. Patients and methods: The study included 100 male patients with mean age of 33.1 +/- 7.5 years; 67 patients of ASA grade I, 27 patients of ASA grade II and 6 patients of ASA grade III. Patients were randomly allocated to two equal groups: Group N received reversal of NMB using intravenous (IV) neostigmine (6 lg/kg) and Group S received IV sugammadex (2 mg/kg). After induction of anesthesia, NM function was monitored, at the wrist; using the TOF-Watch-SX. At the end of the surgery, the reversal of NMB assigned for each group was administered at least after 15 min after the last dose of atracurium and NM monitoring was continued until recovery of the TOF T4/T1 ratio to 0.9. Time since injection of the reversal drug till recovery to TOF ratio of 0.9 was recorded and critical respiratory events (CRE) were monitored. Results: Both groups showed non-significant difference as regards the frequency of patients required top doses of NMBD or the mean number of top doses of NMBD. Time till achievement of TOF ratio of 0.9 was significantly shorter with sugammadex compared to neostigmine. Moreover, mean time to achieve TOF ratio of 0.9 was 2.76 +/- 1.5 min with sugammadex, but was 9.78 +/- 2 min with neostigmine with significant difference in favor of sugammadex. CRE were recorded in 5 patients (5%); 3 patients with neostigmine (6%) and 2 patients (4%) with sugammadex. Conclusion: NMB reversal using sugammadex allowed significantly earlier achievement of TOF ratio of 0.9 in significantly higher number of patients with minimally and acceptable respiratory events at PACU in comparison with neostigmine. (C) 2013 Production and hosting by Elsevier B.V. on behalf of Egyptian Society of Anesthesiologists.