Comparative Evaluation of Sugammadex versus Neostigmine for Reversal of Neuromuscular Blockade in Patients Undergoing Cholecystectomy under General Anesthesia
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Date
2024-11
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Publisher
International Research Organization for Life & Health Sciences
Abstract
Background and Aims: Muscle relaxation is the vital element of general anesthesia. It is attained using neuromuscular blocking agents (NMBAs). After surgery, full restoration of patient’s muscle strength is essential to ensure safe post-operative recovery. The reversal of non-depolarizing NMBAs is achieved using acetylcholinesterase inhibitors or gamma-cyclodextrins. The present study was done to compare Sugammadex and neostigmine for the reversal of vecuronium-induced neuromuscular blockade in patients undergoing cholecystectomy under general anesthesia. Materials and Methods: This prospective randomized double-blinded study was conducted in Guru Nanak Dev Hospital attached to Government Medical College, Amritsar, after taking written informed consent from patients in their vernacular language and approval from the Institutional Ethics Committee. This study was conducted on 60 patients, aged 18–60 years, American Society of Anesthesiologists Grade I and II, scheduled to undergo elective cholecystectomy under general anesthesia. The patients were randomly divided into two groups with 30 patients in each group. At the end of the surgery, when train-of- four (TOF) count reached 2, Group S patients received Sugammadex 2 mg/kg intravenously, and Group N patients received neostigmine 50 mcg/kg and glycopyrrolate 10 mcg/kg combination intravenously to reverse vecuronium induced neuromuscular blockade. Results: The mean time from the study drug administration (at appearance of second twitch T2 after last dose of vecuronium) to tracheal extubation, that is, TOF ratio 0.9 was significantly faster in Sugammadex compared to neostigmine with 2.84 ± 0.592 min (mean ± standard deviation) in Group S and 14.168 ± 2.351 min in Group N. Furthermore, the mean time from study drug administration to operating room discharge ready was 8.92 ± 4.264 min in Group S, and it was 25.064 ± 10.208 min in Group N. Post-operative residual paralysis was not seen in any patient in both the groups. Conclusion: Sugammadex is faster than neostigmine-glycopyrrolate combination in reversing vecuronium-induced neuromuscular blockade. Sugammadex is safe and well tolerated. The incidence of drug-related side effects (post-operative nausea vomiting, post-operative urinary retention) was slightly lower in the Sugammadex group as compared to neostigmine group (10% and 26.6%, respectively).
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Keywords
Neostigmine, Sugammadex, Vecuronium.
Citation
Sharma A, Chatrath V, Marwah D, Kamboj A, Gupta M, Arora A. . Comparative Evaluation of Sugammadex versus Neostigmine for Reversal of Neuromuscular Blockade in Patients Undergoing Cholecystectomy under General Anesthesia. International Journal of Scientific Study. 2024 Nov; 12(8): 27-31