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

Ghoneim AA, El Beltagy MA - Saudi J Anaesth (2015 Jul-Sep)

Bottom Line: In addition, none of the commonly used reversal agents, such as neostigmine or edrophonium are capable of reliably reversing profound blockade.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.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesia and Pain Management, National Cancer Institute, Cairo University, Cairo, Egypt.

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.

No MeSH data available.


Related in: MedlinePlus

Mean of mean blood pressure during reversal of neuromuscular blockade
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Figure 2: Mean of mean blood pressure during reversal of neuromuscular blockade

Mentions: Mean arterial blood pressure and HRs showed no significant difference between both groups at preinduction and throughout the maintenance of anesthesia, with the exception of a statistically higher MAP and mean HR at 2, 5, and 10, min after administration of neostigmine and atropine in the neostigmine group than the preinduction levels as well as than that in the sugammadex group and returned nonsignificantly different at 15 min and at 24 h postoperatively. However, the mean MAP and HRs did not exceed 20% beyond the baseline throughout the previous time periods. The MAP and HR levels were stable and showed no changes than the preinduction levels in the sugammadex group [Figures 1 and 2].


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

Ghoneim AA, El Beltagy MA - Saudi J Anaesth (2015 Jul-Sep)

Mean of mean blood pressure during reversal of neuromuscular blockade
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4478814&req=5

Figure 2: Mean of mean blood pressure during reversal of neuromuscular blockade
Mentions: Mean arterial blood pressure and HRs showed no significant difference between both groups at preinduction and throughout the maintenance of anesthesia, with the exception of a statistically higher MAP and mean HR at 2, 5, and 10, min after administration of neostigmine and atropine in the neostigmine group than the preinduction levels as well as than that in the sugammadex group and returned nonsignificantly different at 15 min and at 24 h postoperatively. However, the mean MAP and HRs did not exceed 20% beyond the baseline throughout the previous time periods. The MAP and HR levels were stable and showed no changes than the preinduction levels in the sugammadex group [Figures 1 and 2].

Bottom Line: In addition, none of the commonly used reversal agents, such as neostigmine or edrophonium are capable of reliably reversing profound blockade.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.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesia and Pain Management, National Cancer Institute, Cairo University, Cairo, Egypt.

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.

No MeSH data available.


Related in: MedlinePlus