Comparison of reversal with neostigmine of low‐dose rocuronium vs. reversal with sugammadex of high‐dose rocuronium for a short procedure

Abstract

Some short procedures require deep neuromuscular blockade, which needs to be reversed at the end of the procedure. Forty-four patients undergoing elective laryngeal micro-surgery were randomly allocated into two groups: rocuronium 0.45 mg.kg with neostigmine (50 μg.kg with glycopyrrolate 10 μg.kg ) reversal (moderate block group) vs. rocuronium 0.90 mg.kg with sugammadex (4 mg.kg ) reversal (deep block group). The primary outcome was the intubating conditions during laryngoscopy secondary outcomes included recovery of neuromuscular block; conditions for tracheal intubation; satisfaction score as determined by the surgeon; onset of neuromuscular block; and postoperative sore throat. The onset of neuromuscular block was more rapid, and intubation conditions and ease of intra-operative laryngoscopy were more favourable, and the satisfaction score was lower in the moderate block group compared with the deep block group. No difference was found in the incidence of postoperative sore throat. In laryngeal micro-surgery, the use of rocuronium 0.9 mg.kg with sugammadex for reversal was associated with better surgical conditions and a shorter recovery time than rocuronium 0.45 mg.kg with neostigmine.

Effects of depth of neuromuscular block on surgical conditions during laparoscopic colorectal surgery: a randomised controlled trial

“…The main focus of the studies are laparoscopic surgeries, for which deep neuromuscular blockade appears to improve surgical conditions . The improved surgical conditions and effectiveness have also been shown in laryngeal microsurgery and in surgery involving morbidly obese patients . However, controversy persists, with conflicting results seen in gynaecological laparoscopic surgery .…”

Neuromuscular blocking agents induced anaphylaxis: Results and trends of a French pharmacovigilance survey from 2000 to 2012

“…Its affinity is 2.5 times higher for ROC than for VEC, and it has no affinity for SUX . Because of this efficient reversal, ROC might be also used for short surgical acts or in surgical environments trying to reduce the stay in operating rooms. Sugammadex has sometimes been reported to improve the management of severe ROC anaphylaxis at the beginning of its use, but today, this action remains controversial because i) the improvement may be coincidental with the already instituted therapy with epinephrine and fluid resuscitation, ii) the possibility of encapsulated ROC to be able to interact with IgE cannot be ruled out, and iii) sugammadex has not been shown to interact with mast cell degranulation yet .…”

Quality improvement studies – pitfalls of the before and after study design

“…In addition, this agent enables the use of large doses of rocuronium at induction to produce rapid onset and profound paralysis, even for short procedures, without the inconvenience of delayed or inadequate reversal of neuromuscular blockade. This can result in superior operative conditions for different types of surgical procedures . On the other hand, the agent is expensive, not widely available and is only efficacious for aminosteroid neuromuscular blocking agents.…”