Sugammadex versus neostigmine in pediatric cancer patients undergoing outpatient surgical procedures

Abstract

Neuromuscular blocking agents (NMBAs) are still required for the pediatric population. Residual neuromuscular block is a common complication in the early postoperative period. The objective of this study is to compare the efϑicacy of sugammadex versus neostigmine for reversing NMB in pediatric patients with cancer who undergo outpatient surgical procedures. This double-blinded study included 80 children with different oncological diagnoses, aged 2-18 years, scheduled for outpatient surgical procedures. They were randomly divided into two equal groups; Group N received neostigmine 0.03 mg/kg with atropine 0.02 mg/kg and Group S received sugammadex 2 mg/kg at the end of surgery. The patients were clinically assessed for NMB recovery and extubated. The primary outcome measure was the time from NMB reversal to recovery of the TOF ratio to 0.9% (recovery time). The secondary outcomes included the time between reversal injection and extubation (extubation time) and possible adverse events. The time to recovery of the TOF ratio to 0.9 and the time between reversal injection and extubation were signiϑicantly shorter in S Group (p< 0.001). The time to reach TOF ratio of 0.9 was not correlated with age, anesthesia time, or the dose of the neuromuscular blocker. None of the children developed respiratory depression or postoperative residual curarization. Relatively few patients developed arrhythmia, hypotension, and nausea and vomiting with no signiϑicant difference between the two groups. Sugammadex is a good alternative to neostigmine for reversal of neuromuscular block in outpatient surgical procedures in children with cancer; it safely provides faster NMB reversal and extubation time.