Comparative study between sugammadex and neostigmine in neurosurgical anesthesia in pediatric patients

Abstract

Background:Postoperative recurarization remains a risk following the use of the conventional neuromuscular blocking agents. In addition, none of the commonly used reversal agents, such as neostigmine or edrophonium are capable of reliably reversing profound blockade. The present comparative and randomized study investigated the use of sugammadex for reversing profound neuromuscular blockade (NMB) in pediatric neurosurgical patients undergone posterior fossa tumor excision.Patients and Methods:Forty pediatric patients undergoing elective craniotomy for posterior fossa tumor excision were randomly divided into either of neostigmine or sugammadex group in which muscle relaxant was reversed at the end of anesthesia either with neostigmine 0.04 mg/kg added to atropine 0.02 mg/kg or sugammadex 4 mg/kg alone, respectively. The primary endpoint was the time from the administration of sugammadex or neostigmine to recovery of the train of four (TOF) ratio to 90% after rocuronium-induced neuromuscular block. Unpaired t-test was used to compare continuous variables between groups. Meanwhile, repeated ANOVA was used to detect intragroup differences.Results:Patients in sugammadex group attained a TOF ratio 90% in statistically shorter time (1.4 ± 1.2 min) than those in neostigmine group (25.16 ± 6.49 min) for reversal of the rocuronium. Mean arterial pressure and heart rate were significantly higher in neostigmine group at 2, 5 and 10 min after administration of the reversal agents and returned nonsignificantly different after that. With no recurarization in any patient throughout the study period.Conclusion:Sugammadex rapidly and effectively reverses rocuronium-induced NMB in pediatric patients undergoing neurosurgery when administered at reappearance of T2 of TOF at dose 4 mg/kg.

A comparison of sugammadex and neostigmine for reversal of rocuronium‐induced neuromuscular blockade in children

“…Matching with our outcome, Ghoneim et al, used sugammadex in a dose of 4 mg/kg at reappearance of T2 of TOF to reverse rocuronium‐induced NMB in paediatric patients undergoing neurosurgery. The recovery time was statistically shorter in the sugammadex group (1.4 ± 1.2 min) than those in neostigmine group (25.2 ± 6.5 min) without PORC or any major adverse events in any patient throughout the study period.…”

“…Multiple trials have reported safety and superiority of sugammadex over neostigmine for reversal of NMB in adults . However, few studies have concerned sugammadex use in paediatric patients …”

The efficacy and safety of sugammadex for reversing postoperative residual neuromuscular blockade in pediatric patients: A systematic review

“…In one study 26 reversal agents were administered at different times between the sugammadex group (PTC < 2–3) and the control group (PTC > 2–3), which we believe may have influenced the primary outcome. We believe that one trial 23 had a low risk of bias because all of the study criteria were assessed as low risk, whereas three trials 25, 26, 28, 30, 31 had high risks, and the risks of other studies 24, 27, 29, 32 were unclear. Assessments of risk of bias are summarized in Fig.…”

“…Six studies 24–27, 29, 32 were unclear about their allocation concealment. Four studies 24, 25, 29, 31 did not report whether the patients and the assessors were blinded during outcome assessments. In the study conducted by El sayed 30 , the assessors were not blinded to the allocation of groups, which may have affected the results of the study; therefore, we evaluated the study as ‘high risk’.…”

Sugammadex: Applications in Pediatric Critical Care

“…Several other prospective studies have compared reversal of neuromuscular blockade using sugammadex with the acetylcholinesterase inhibitor, neostigmine (►Table 1). [27][28][29][30][31] These five prospective trials involving a total of 287 pediatric patients have demonstrated various clinical advantages of sugammadex over neostigmine including a more rapid return of the TOF ratio to ! 90% and a shorter time to tracheal extubation with sugammadex than with neostigmine.…”