A Comparative Study between Neostgmine and Sugammadex in Reversal of Recuronium-induced Neuromuscular Block in Caesarean Section Patients

Abstract

Sugammadex is one of the most innovative drugs in anesthesia in recent years. It is the first drug that encapsulates the NMBD, taking it away from the NMJ and terminating its action, thus allows increased flexibility with NMBDs intraoperatively. The drug is a modified gamma-cyclodextrin that is water soluble but has a lipophilic cavity that traps the NMBA. The formation of this sugammadex / NMBA complex results in a reduction in the amount of free circulating NMBA, leaving the receptor available for binding to ACh. Sugammadex acts selectively against the steroidal NMBAs rocuronium and vecuronium but has little or no activity against nonsteroidal NMBAs (e.g. succinylcholine, atracurium, cisatracurium). There is no evidence that sugammadex is metabolized; the drug is primarily eliminated via the renal route as unchanged drug. In the present study, we demonstrated that routine reversal from rocuroniuom-induced neuromuscular blockade was faster with sugammadex than neostigmine. We conducted this on 80 patients undergoing elective Cesarean sections under general anesthesia, (ASA I, II) .age (20-40year) all patients received rocuronioum 0.6 mg/kg. Patients were randomized to two equal groups 40 patients each (sugammadex group) received sugammadex 2mg/kg for reversal block induced by rocuroniuom and (neostigmine group) received neostigmine 50ug/kg and 20ug/kg atropine. Neuromuscular function was monitored using acceleromyography (TOF -watch), sugammadex or neostigmine was administered at reappearance of T2. The primary efficacy variable was time for recovery of the train-of-four (TOF) ratio to 0.9. Recording recovery time by (TOF) in two groups showed statistically significant differences (P-value < 0.05). All sugammadex treated 40 patients achieved a TOF ratio of 0.9 in < 5 min and mean time of recovery was (2.44±1.25) min compared with neostigmine group which was <15min and mean recovery time was (8.675±2.72) min. Regading hemodynamics (HR, MAP) RR and SPO2, comparison was done immediately before (baseline) administration of reversal drugs and after administration. Compared to sugammadex, use of neostigmine atropine was associated with significantly higher HR values at 5min, 10min and higher MAP values at 2min, 5min, 10min after reversal administration (p-value <0.05). Sugammadex had no significant changes on HR and MAP. Regarding respiratory rate, was recorded at 2min, 5min, 10min. There was no statistically significant differences in sugammadex patients while, use of neostigmine atropine was associated with significantly higher RR values at 10min after reversal administration (p-value <0.05). Regarding oxygen saturation (spo2%), compared to sugammdex, use of neostigmine atropine was associated with significant differerence in SpO2% values before administration (baseline) (98.875±0.853) and after administration at 2min (97.825±0.712), 5min (98.200±0.723). 10min (99.175±0.813) (p-value <0.05), while there was no statistically significant differences in sugammadex group (p-value> 0.05). In our study we recorded the incidence of nausea and vomiting was higher in neostigmine group, the results showed and statistically significant difference among the two groups. The incidence of abdominal colic was higher in neostigmine group, this was statistically significant different among the two groups.