Abstract PR253

Abstract

Background & Objectives: For almost a decade, a novel drug sugammadex has been used to specifically antagonize the effect of aminosteroidal neuromuscular blocking agents. The aim of this study is to compare the recovery time, haemodynamic stability and complications between these 2 reversal agents, sugammadex and neostigmine in antagonizing the effects of rocuronium in the paediatric population. Materials & Methods: This was a double-blinded, randomized controlled trial involving 80 paediatric patients aged between 2-12 years old scheduled for surgery under general anaesthesia with rocuronium neuromuscular blockade. They were randomized into two groups, for reversal with neostigmine or sugammadex. All patients were induced with sevoflurane, while IV access was obtained, then 2mcg/kg of fentanyl was given. Neuromuscular function monitoring of the adductor pollicis muscle was done by train-of-four method (TOF) using the TOF-Watch SX. 2 electrodes were placed along the ulnar groove of the hand and the transducer at the thumb and calibrated. 0.6mg/kg of rocuronium was given and all patients were intubated once TOF response was not detected. TOF was monitored and maintained at count of 2-3 throughout the surgery with 0.2mg/kg of rocuronium. The haemodynamic parameters pre- and post-reversal were documented. Once surgery finished the patients were reversed according to the group allocated, 0.05mg/kg of neostigmine with 0.02mg/kg of atropine or 2mg/kg sugammadex. The neuromuscular recovery time, from reversal administration at TOF count 2 or 3 to TOF ratio 0.9 was documented. The patients were extubated at TOF 0.9, any complications observed post-extubation were also documented. Results: There was significant faster and statistically significant (p = 0.001) in neuromuscular recovery time from TOF count 2 or 3 to TOF ratio 0.9 post-reversal in thesugammadex group, with a mean of 84.45 ± 42.67 seconds as compared to only 501.58 ± 115.82 seconds in the neostigmine group. The time from reversal to extubation was also significantly faster (p= 0.001) in the sugammadex group with mean time of 105.77 ± 32.86 compared to neostigmine 712.98 ± 132.45. There were no significant changes in the means of systolic blood pressure, diastolic blood pressure and mean arterial pressure pre-reversal and post-reversal in both groups. However there was significant increase in the heart rate in neostigmine group after reversal. The incidence of complications post-reversal was higher in the neostigmine group with 17.5% (7 patients) post-operative nausea vomiting, no complications were noted in the sugammadex group. Conclusion: Sugammadex has a significantly shorter recovery timeand less complications as compared to neostigmine. Disclosure of Interest: None declared