Evaluation of efficacy of sugammadex for reversal of neuromuscular blockade in patients undergoing major upper abdominal surgery.

Introduction: Rapid and complete reversal of neuromuscular blockade (NMB) allows for the adequate return of respiration and motor function, thereby expediting recovery and preventing micro-aspirations postoperatively. Diaphragmatic ultrasonography (DUS) is an easy, noninvasive and reliable diagnostic tool to quantify and assess respiratory function and exclude any postoperative residual curarization (PORC). Sugammadex, a modified gamma cyclodextrin reverses NMB faster and more reliably from a deep or profound blockade. We aimed to evaluate the efficacy of Sugammadex for the reversal of NMB in patients undergoing major upper abdominal surgery and to determine the risk of PORC using DUS.

Methods: The present prospective, observational study included patients aged 18-65 years undergoing major upper abdominal surgery. The participants of Group A received Sugammadex and Group B received Neostigmine-Glycopyrrolate as reversal agent. Time of extubation and diaphragmatic thickness was noted at base line, 10 min-30 min postextubation. The statistical analysis was done using SPSS (Statistical Package for the Social Sciences) Version 21.0.

Results: The time required to extubate was significantly shorter in Group A as compared to Group B (81.96 ± 37.30 s vs. 204.20 ± 99.91 s, P < 0.001). The diaphragm thickness at 10 min after extubation was higher in Group A compared to Group B (0.42 ± 0.04 cm vs. 0.4 ± 0.04 cm, P = 0.043).

Conclusion: Sugammadex is more effective in achieving rapid reversal of NMB compared to neostigmine. The use of diaphragm ultrasonography provides valuable insights into respiratory function and the risk of PORC postoperatively.