Comparison between sugammadex and neostigmine–atropine in morbidly obese patients during anesthesia in ophthalmic surgery

Abstract

Background Sugammadex provides fast and complete recovery from rocuronium-induced neuromuscular blockade. The objective of this study was to compare between the effect of sugammadex and neostigmine on intraocular pressure (IOP), hemodynamics, and postoperative complications in morbidly obese patients. Patients and methods A prospective randomized study was done to study the effect of sugammadex and neostigmine on IOP in morbidly obese patients during elective eye surgery. A total of 60 morbidly obese patients (BMI >35 kg/m2) American Society of Anesthesiologists I–II, aged between 35 and 55 years, requiring general anesthesia and who received rocuronium for muscle relaxation were randomly assigned into two groups: group I (n=30) (Sug) received sugammadex 2 mg/kg and group II (n=30) (Neo) received neostigmine of 0.05 mg/kg at the end of surgery when response of train-of-four reached T2 by using peripheral nerve stimulator. The neuromuscular function was recorded and time to achieve 90% of train-of-four (safe extubation) was measured. After extubation was done, the IOP was measured 1, 2, 5, 10, and 20 min for all patients (those with baseline IOP of >30 mmHg were excluded). Tono-Pen XL applanation tonometer was used to measure IOP. Heart rate and blood pressure were measured and compared in both groups. Patients were examined directly after arrival to the recovery room for observation of complications. Results Sugammadex give safe, fast, and complete recovery in morbidly obese patients, lower values of IOP and minimal effect on hemodynamics during ophthalmic operations. Conclusion Sugammadex provided a more rapid reversal of neuromuscular functions in morbidly obese patients, lower IOP and hemodynamic stability during ophthalmic operations.