Sugammadex versus two doses of neostigmine for reversal of rocuronium in gastric sleeve surgery

Background and Aim: The aim of this prospective randomized trial is to compare the quality of reversal of rocuronium with either sugammadex (SUG) versus 2.5 mg or 5 mg neostigmine (NEO). Patients and Methods: A total of 110 patients with body mass index >40 underwent elective gastric sleeve surgery were enrolled in this study. Exclusion criteria included patients with co-existing muscular and cardiovascular diseases. Patients were randomly allocated to one of the following groups: group A (SUG), Group B (NEO 2.5 mg), and Group C (NEO 5 mg). General anesthesia was induced in the three groups using propofol 2.0 mg/kg of corrected body weight (CBW) and fentanyl 3 mcg/kg of CBW. Anesthesia was maintained with O2/air/desflurane 1 minimum alveolar concentration. Remifentanil infusion started at 0.05–0.2 mcg/kg/min. Tracheal intubation was facilitated with rocuronium 1.2 mg/kg of CBW guided with PNS. When the train of four (TOF) reached zero, intubation was performed using a GlideScope. At the end of surgery, TOF ratio and posttetanic counts were recorded. SUG 2 mg/kg of CBW (Group A), NEO 2.5 mg (Group B), and NEO 5 mg (Group C) were administered according to the random envelope. The time to achieve 90% of TOF was recorded in seconds using a timer. ANOVA for repeated measurements was used for statistical analyses. P<0.05 was considered statistically significant. Results: There was a positive correlation (P < 0.05) between the duration of surgery and the time to reach 90% of TOF in all the three groups. The time to reach 90% TOF was significantly shorter with Group A versus Groups B and C (P < 0.05). Conclusion: Although SUG proved to be faster than NEO 5 mg in attaining TOF >90%, the recovery pattern of both was similar.