Rocuronium reversal: sugammadex versus neostigmine in asthmatic patients undergoing open cholecystectomy

Abstract
Sugammadex is a new selective relaxant binding drug that provides a rapid decrease in free rocuronium in the plasma and also at the nicotinic receptor that helps in proper awakening of patients, which is extremely helpful for minimizing postoperative respiratory complications. The aim of this study is to compare the recovery profile of sugammadex versus neostigmine in asthmatic patients undergoing open cholecystectomy.
Methods
This study included 60 patients of ASA physical status II, aged 45–55 years with controlled bronchial asthma undergoing open cholecystectomy. General anesthesia was induced with propofol (2–3 mg/kg), fentanyl 1 μg/kg, and then rocuronium 0.6 mg/kg was administered to facilitate tracheal intubation (train of four (TOF) guarded). Muscle relaxation was maintained throughout the procedure with additional bolus doses of rocuronium 0.15 mg/kg which were administered upon appearance of the second twitch in TOF to maintain neuromuscular block during surgery. Patients were allocated randomly into two equal groups: (group I) received sugammadex 4 mg/kg, and (group II) received neostigmine 0.05 mg/kg and atropine 0.02 mg/kg (group II) as a reversal agent. Assessment of pulmonary function tests on the day before and 30 min after extubation was made. In addition capillary hemoglobin oxygen saturation was measured as well as the reversal time.
Results
The reversal time showed highly significant differences between the two groups: 2.5–3 min in group I versus 21–25.3 min in group II. Pulmonary function tests (PFT) and number of patients unable to perform sustained head elevation for 5 s showed non-significant differences between the two groups.
Conclusion
This study showed that the benefits of sugammadex are superior to those of neostigmine in reversing rocuronium-induced neuromuscular blockade in asthmatic patients undergoing open cholecystectomy.