Sugammadex versus neostigmina en pacientes pediátricos: estudio prospectivo y aleatorizado

Background and objectives

Acetylcholinesterase inhibitors may cause postoperative residual curarization when they are used for reversal of neuromuscular blockade. Sugammadex reverses neuromuscular blockade by chemical encapsulation and is not associated with the side effects that may occur with the use of anticholinesterase agents. Because of increased outpatient surgical procedures postoperative residual curarization and rapid postoperative recovery have a greater importance in the pediatric patient population. The aim of this study was to compare the efficacy of sugammadex and neostigmine on reversing neuromuscular blockade in pediatric patients undergoing outpatient surgical procedures.

Methods

80 patients, aged 2-12 years, scheduled for outpatient surgery were enrolled in this randomized prospective study. Neuromuscular blockade was achieved with 0.6 mg kg⁻¹ rocuronium and monitorized with train-of-four. Group RN (n = 40) received 0.03 mg kg⁻¹ neostigmine, Group RS (n = 40) received 2 mg kg⁻¹ sugammadex for reversal of rocuronium. Extubation time (time from the reversal of neuromuscular blockade to extubation), train-of-four ratio during this time, time to reach train-of-four > 0.9, and probable complications were recorded.

Results

There was no significant difference between the patients’ characteristics. Extubation time and time to reach train-of-four > 0.9 were significantly higher in Group RN (P = .001, P = .002). Train-of-four at the time of neostigmine/sugammadex injection in Group RN were significantly higher than in the RS group (P = .020). Extubation train-of-four ratio was significantly lower in Group RN (P = .002).

Conclusion

Sugammadex provides safer extubation with a shorter recovery time than neostigmine in pediatric patients undergoing outpatient surgical procedures.