Sugammadex versus neostigmine for reversal of rocuronium-induced neuromuscular blockade in infants: A prospective randomized pilot study

Abstract

BackgroundThis study aimed to compare sugammadex and neostigmine for the antagonism of rocuronium-induced neuromuscular block in pediatric patients with biliary atresia and impaired liver function undergoing Kasai operation. MethodsForty pediatric patients below three months of age underwent the Kasai operation. When the surgery ended and the second response (T2) to train-of-four (TOF) stimulation was detected, patients were randomly assigned to receive either 50 µg/kg neostigmine combined with 20 µg/kg atropine, or 2 mg/kg sugammadex. We recorded the time between receiving the neostigmine or sugammadex and reaching corrected TOF ratios of 0.9 and 1.0.We also noted their length of stay in the post-anesthesia care unit (PACU) and any incidents of postoperative recurrence of neuromuscular blockade or other adverse events during recovery. ResultsThe times taken to reach TOF ratios of 0.9 and 1.0 after sugammadex were shorter than after neostigmine (p<0.001). The mean duration of PACU stay was also shorter with the use of sugammadex compared to neostigmine (22.55±5.76 min vs. 40.50±7.93 min; p<0.001). We did not record any incidents of postoperative recurrence of neuromuscular blockade after administration of either treatment .The total number of patients who suffered from post-operative vomiting were statistically lower in the sugammadex group than in the neostigmine group (2 vs. 9; p = 0.03). One patient (5%) in the sugammadex group versus 13 patients (65%) in the neostigmine group developed tachycardia (p<0.001). ConclusionsSugammadex at a dose of 2.0 mg/kg is a safe, quick, and efficacious reversal agent to rocuronium-induced neuromuscular blockade (NMB) in pediatric patients below three months of age undergoing the Kasai operation, with a lower incidence of post-operative tachycardia, vomiting, and shivering than neostigmine.