Comparative Study of Sugammadex Versus Neostigmine Reversal of Rocuronium Induced Neuromuscular Blockade in Patients Undergoing Bronchoscopic Lung Biopsy

Abstract

After bronchoscpic surgeries there is a risk of respiratory complications, but this risk increases if residual paralysis occurs postoperatively. This study was designed to compare sugammadex versus neostigmine reversal of moderate rocuronium-induced neuromuscular blockade in patients undergoing bronchoscopic lung biopsy. This prospective randomized blind study was carried on 40 American Society of Anesthesiologists III&IV adult patients of both sexes aged over 60 years scheduled for bronchoscope upper lung mass biopsies, to evaluate the incidence of postoperative residual curarisation and to assess the appearance of any sign of muscle weakness and respiratory depression or distress. Patients were randomly assigned to one of 2 groups: group N: neostigmine Group N 50μg/ kg together with atropine 0.02 mg/kg) or group S: Sugammadex 2.0 mg/kg. All patients were observed for six hours for postoperative residual curarisation (PORC). Assessment of any signs of muscle weakness and respiratory depression or distress was done. As regard TOF % ratio at 15 min at PACU, there was significant increase in group S compared with group N with P values was <0.001. In group S there was no patient developed recurrence of neuromuscular block (NMB), while in group N there were 4 patients developed recurrence and treated with oxygen face mask and another reverse was given. Signs of respiratory distress or impending ventilator failure were significantly higher in the group N. Only two cases in group S develop hyperpyrexia with body temperature more than 38 after 4 days but with normal leukocytic count, but there were 4 cases in the group N developed hyperpyrexia with leukocytosis. So we concluded that postoperative recovery and postoperative pulmonary condition were improved with the use of sugammadex more than with neostigmine in patients with upper lung masses undergoing bronchoscopic mass biopsies.