Comparison of recovery characteristics of sugammadex versus neostigmine in the elderly patient undergoing rigid bronchoscopy: A randomised controlled trial

All eligible participants will be seen the primary investigator one day prior to surgery and written informed consent will be taken. NPO instructions will be explained to the patient. On the day of surgery, Elderly will receive IV midazolam pre-operatively 0.5 mg/kg if needed or requested, 20-30 minutes before induction. ASA standards monitoring -oxygen saturation probe (SPO2), ECG, NIBP will be attached simultaneously. Intravenous induction will be done by IV fentanyl (1-2 µg/kg) followed by IV Propofol (2-2.5 mg/kg) or Etomidate (0.2-0.6mg/kg) followed by muscle relaxant Rocuronium (0.4-0.6 mg/kg). A rigid bronchoscope with side ventilation port will be used for mechanical ventilation.

Maintenance of anesthesia will be by sevoflurane to achieve approximately 0.8-1 MAC. Fentanyl will be repeated as per clinical requirement in 0.5 µg/kg aliquots. This will be documented. Rocuronium maintenance doses will be guided by neuromuscular monitoring (Target of 0-1 TOF count). Intraoperative outcomes and drug requirements will be measured. At the end of surgery,

• Group A participants will receive 0.05mg/kg of Neostigmine and 0.01mg/kg glycopyrrolate IV for muscle blockade reversal at the end of surgery when TOF ratio <0.4 or TOF count 2-3.
• Group B participants will receive 2mg/kg of Sugammadex IV at the end of surgery after achieving 1-2 TOF count, or 4 mg/Kg when no twitch responses to TOF stimulation.

Extubation time is calculated from the time sugammadex or neostigmine is given till TOF>0.9 is achieved in patient for extubation

Haemodynamic and clinical parameters will be measured throughout the surgery and in the PACU. All elderly will be assessed for post pulmonary complication in PACU for 1 hour and in ward till patient is discharged from hospital.