A Comparative Study between Sugammadex versus Neostigmine as Regards Efficiency of Reversal of Rocuronium and Bleeding Tendency Effect after Septoplasty
Authors: Awad A G , Rabie A H A , Elshafie M A A , Youssef G F K 
Published: May 2020

Abstract

Backround
Sugammadex is a reversal agent with well-known advantages but its effects on coagulation profile, reversal time and hemodynamic parameters have been a topic of interest. Septoplasty is a common surgical procedure with postoperative respiratory complications and bleeding.

Aim of the Work
the purpose of this study was to compare the efficacy of different doses of sugammadex versus neostigmine for rocuronium reversal in septoplasty surgery regarding its effects on the reversal time, occurrence of residual paralysis, incidence of adverse events, hemodynamic parameters and effect on coagulation profile.

Patients and Methods
this study was conducted in Ain Shams University Hospital. After obtaining approval of research ethical committee and patients’ informed consents. Sixty (60) patients of both sexes, aging between 25- 50 years old, with ASA status I – II. Induction of anesthesia was achieved by intravenous injection of fentanyl 1-2 mcg/ kg and propofol 2-2.5 mg/ kg. Rocuronium 0.6 mg/ kg was administered intravenously. At the end of the surgical procedure, when spontaneous recovery of neuromuscular blockade occurs with the appearance of T2, anesthesia was withdrawn and the neuromuscular block was reversed using IV injection of 1, 2 or 4 mg/ kg sugammadex or neostigmine sulfate 0.04 mg/kg with atropine sulfate 0.02mg/ kg.

Results
as regards gender, age, weight, height and ASA stat, signs of residual paralysis, incidence of adverse effects there was no statistically significant differences found between groups. Regarding the comparison between the reversal times of the 4 groups, a highly statistical significance was found between the 4 groups. The heart rate showed a high statistical significance between the four groups at 2 and 10 minutes but they showed a lesser significance at 30 minutes. Mean arterial pressure increased in neostigmine group 2min, 10 min after the medication. Sugammadex group had lower heart rate when compared to neostigmine group, (N&gt;S1&gt;S2&gt;S4). Lastly, considering the coagulation profile, At 30 minutes after drug administration, there was a mild increase in PT and PTT in S2 group with moderate increase in S4 group that return to normal values again at 120 minutes.

Conclusion
we have designed a study to compare the efficacy of different doses of sugammadex versus neostigmine for rocuronium reversal and studied its effects on hemostasis in septoplasty surgery regarding the reversal time, occurrence of residual paralysis, incidence of adverse events, hemodynamic parameters and effect on coagulation profile. Sugmmadex proved to have a lesser reversal time in all its studied doses compared to neostigmine with a TOF (T4:T1) ratio 0.9. We studied the effect of sugammadex for neuromuscular blockade in terms of PONV, we found no differences regarding this issue between both drugs. Although there were increases on hemodynamic parameters in both N and S groups, this increase was more prominent in patients receiving neostigmine. Finally, our study demonstrated that sugammadex caused mild and transient elevation in PT and aPTT values within 30 minutes then returned to their normal levels within 120 minutes.