Sugammadex versus neostigmine in reversal of rocuronium-induced neuromuscular block in obese patients

Abstract

Background Obese patients are especially susceptible to critical respiratory events in the postoperative period, including airway obstruction, hypoventilation, hypercapnia, hypoxia, and postoperative residual curarization (PORC); hence, rapid and complete reversal of neuromuscular blockade (NMB) is desirable at the end of surgery. Objective This study aimed to compare between the effect of sugammadex and neostigmine on recovery time, PORC and estimate postoperative complications at the postanaesthetic care unit in obese patients. Patients and methods Seventy obese patients, BMI greater than 35 kg/m2 American Society of Anaesthesiologist class I–II, scheduled for a surgical procedure under general anesthesia were included in this study. Patients received rocuronium for muscle relaxation, and, at the end of the surgery, patients were divided randomly into two groups: one group received sugammadex 2 mg/kg of ideal body weight (group S) and the other group received neostigmine 0.05 mg/kg plus atropine 0.01 mg/kg of ideal body weight (group N) to reverse the NMB. NMB was monitored using train-of-four (TOF). At reappearance of the second twitch (T2) of TOF, patients received the study drugs, and time to reach (TOF) greater than 0.9, was recorded. All patients were observed at the postanaesthetic care unit for one hour for PORC and haemodynamic value (heart rate, mean arterial pressure, and SpO2) by a blinded investigator. Results At the end of surgery extubation was done when reached a train-of-four (TOF %) score of 2, patients at this percentage received the study drugs the neuromuscular function was recorded and time to achieve 90% of TOF (safe extubation) was measured. Train-of-four (TOF%) is the ratio of the fourth muscle response to the first one. It meaning median time to recovery of the T4:T1 ratio to 0.9. Conclusion Administration of sugammadex provides fast recovery of neuromuscular function than neostigmine following NMB by rocuronium and prevents PORC in obese patients.