Effect of Sugammadex versus Neostigmine Reversal on Lung Aeration Score after Operative Fixation of Cervical Spine:A Prospective, Double Blinded, Randomised Control Trial

Post operative pulmonary complications (POPC) are one of the leading contributors of prolonged hospital stay. The incidence of respiratory complications in patients with cervical spine injury (CSI) is well reported and the pathophysiology behind these complications after CSI is complex and multifactorial. Surgical decompression is often recommended for both traumatic and degenerative cervical spine pathologies currently. The altered lung mechanics during corrective surgery further contributes to the development of pulmonary morbidities. Residual neuromuscular blockade after surgery is one common culprit behind the development of pulmonary complications subsequently. Sugammadex, a gamma-cyclodextrin compound has shown promising results in reducing the incidence of POPC in different subgroup of patients. It has been postulated that, due to the unique mechanism, sugammadex is able to reverse the effect of steroidal non-depolarizing neuromuscular blocking agents more efficiently as compared to traditional neostigmine reversal. There is no available study where sugammadex was used in CSI patients.

Lung ultrasound is an easy and effective modality to detect several underlying respiratory pathologies. Depending on the number of B-lines found in specific areas during sonography, a quantitative scoring system have been postulated which have been widely used in various settings for prediction of weaning from mechanical ventilation, for ventilatory strategy intraoperatively as well as in ARDS patients, for perioperative assessment of the lung aeration etc. Lung aeration score has been successfully used to predict POPCs after major abdominal surgeries.  In this prospective, double-blind randomized control trial, we hypothesize that Sugammadex reversal will result in a lower i.e., better lung aeration score 24 hrs after surgery as compared to the neostigmine group. We have, therefore, planned this study to compare the effect of sugammadex to neostigmine on the lung aeration score after surgical fixation of CSI.