Effect of Sugammadex versus neostigmine reversal on lung aeration score after operative fixation of cervical spine: A prospective, double blinded, randomised control trial.

Background and aims: Traumatic cervical spine injury (tCSI) is associated with an increased risk of postoperative pulmonary complications (POPC) after surgical fixation. Sugammadex provides superior neuromuscular recovery; however, its effectiveness in reducing POPC in tCSI remains unclear. The primary outcome of this study was the ultrasonographic lung aeration score (LAS) at 24 hours after surgery. Secondary outcomes included extubation success in the operation theatre, POPC, length of intensive care unit stay, duration of mechanical ventilation, need for tracheostomy, hospital stay after surgery, and in-hospital mortality.

Material and methods: In this prospective, double-blinded, randomised control trial, 75 patients undergoing elective fixation of tCSI were randomly allocated to either the neostigmine (N) group (n = 37) or sugammadex (S) group (n = 38) for neuromuscular blockade (NMB) reversal. A P value less than 0.05 was considered statistically significant.

Results: There was no significant difference in LAS at 24 hours between groups [median (range) LAS: 2 (0-18) in the N group, 2 (0-19) in the S group] (P = 0.632) or in any other secondary outcomes. The incidence of POPC was 27.03% in the N group and 26.32% in the S group (P = 0.944) Exploratory analysis did not find any difference in outcomes based on the level [high (C1-C4) vs. low (C5-C7)] or severity [American Spinal Injury Association (ASIA) impairment scale: A, B vs. C, D, E] of spinal injury (P > 0.05). A LAS of 4 at 24 h predicted the development of POPC within 7 days with 80% sensitivity and 87.27% specificity (area under the receiver operator characteristics curve: 0.9032).

Conclusion: In tCSI, NMB reversal using either sugammadex or neostigmine resulted in comparable LAS at 24 h postoperatively following cervical spine fixation. Additionally, a LAS of 4 was found to be a strong predictor of POPC within a 7-day follow-up period.