Sugammadex Efficacy for Rapid Reversal of Rocuronium Induced Neuromuscular Blockade in Pediatric Rigid Bronchoscopy Regardless the Depth of Anesthesia

Abstract

Background: Bronchoscopy may be either rigid or flexible. Rigid bronchoscopy is usually done for diagnosis and treatment of intra and/or extra luminal obstruction in the airway for adults and children, anaesthesia for bronchoscopy poses unique challenges for the anaesthesiologist. This procedure needs specific technical precision because both the anaesthesiologist and operator share the same working space, that is, the airway. Pediatric rigid bronchoscopy needs a deep level of general anesthesia with a good (profound) muscle relaxation for a short time, with the modern anesthetic muscle relaxant rocuronium Bromide and its unique rapid onset it gives chance to be used in challenging airway procedures like rigid bronchoscopy and with the its newly advent of selective reversal, sugamadex, encourage its use in pediatric rigid bronchoscopy as it is usually performed for Foreign body removal. Aim: The aim of this study is to compare the efficacy of sugammadex and neostigmine for reversal of neuromuscular blockade induced by rocuronium for facilitating interventional rigid bronchoscopy and having awake child with good adequate muscle power and good ability to protect airway reflexes. Methods: This study was done on 100 patients ASA1-11 underwent rigid bronchoscopy for foreign body aspiration, we compared the efficiency of both neostigmine and the newly selective reversal agent; sugamadex in recovery of the patients, hemodynamics, and the presence of any side effects. Results: Our results showed that no significant changes between two groups in Table 1, Table 2, Table 3 i.e. heart rate, arterial blood pressure and O2 saturation (%) during all period of study i.e. Base line, Strating study drug, 2 min, 5 min, 10 min. But in Table 4, Table 5, Table 6 i.e. Time (in min) from administration at study drug until recovery (TOF>0.9) , extubation time in min (from administration at study drug until extubation), Recovery time (from administration at study drug until Aldrete score more than 9) the time was significantly shorter in group (1) when compared with group (2) which was (3.6 ± 2.6, 3.9 ± 2.6 and 7.3 ± 1.9) in group (1) and (15.12 ± 1.85, 15.85 ± 1.85 and 19.59 ± 2.3) in group (2). In Table 7, there was no significant difference in the side effects between both groups. Conclusion: Sugammadex achieved significantly faster recovery of rocuronium-induced neuromuscular block when compared with neostigmine regardless the depth of anesthesia. Serious adverse events were less than 1% of patients in both sugammadex and neostigmine, and data showed no differences in risk of serious adverse events between groups. sugammadex was well tolerated.