Effect Of Rocuronium- Sugammadex Versus Atracurium - Neostigmine On Time To Extubation: A Randomized Parallel Group Study

Introduction:Efficient anaesthesia reversal is essential for optimizing operating room (OR) time and patient outcomes. Rocuronium (reversed by sugammadex) and atracurium (reversed by neostigmine) are commonly used. Sugammadex offers faster reversal but is costly and often unavailable in resource-limited settings. Current studies focus on time from reversal agent administration, not from surgical completion, missing critical OR time delays. This study addresses that gap by comparing time to extubation from end of surgery, evaluating clinical outcomes and cost-effectiveness, particularly in the Indian healthcare context. Objectives:Primary Objective: Compare time from surgical dressing to extubation between Rocuronium-Sugammadex (RS) and Atracurium-Neostigmine (AN) groups. Secondary Objectives: Time from extubation to OR exit Incidence of postoperative adverse events (within 24 hours) Rationale & Novelty:Sugammadex is new in India; its cost and lack of monitoring tools limit usage. Previous studies measured reversal time from drug administration, not surgical end. No Indian studies use clinical criteria for reversal timing. The study offers a real-world, clinically relevant evaluation that may influence practice and cost management. Hypothesis:Rocuronium-sugammadex leads to a shorter time to extubation from end of surgery compared to atracurium-neostigmine. Methodology:Design: Randomized parallel group study Duration: 12 months (8 months data collection, 2 months analysis & writing) Population: 60 adult patients (30 per group), aged 19–60, ASA I–II, undergoing elective surgery under GA lasting 30 min–3 hrs Randomization: 1:1 allocation Intervention: Group AN: Atracurium + Neostigmine-Glycopyrrolate (on spontaneous effort) Group RS: Rocuronium + Sugammadex (immediately after dressing; repeated every 3 mins up to 16 mg/kg as needed) Extubation Criteria: Awake, responsive, stable vitals, adequate spontaneous breathing Post-op Monitoring: 24 hours for complications (desaturation, obstruction, re-intubation) Sample Size:Although minimum of 4 patients (2 per group) was statistically sufficient, 30 per group were recruited to improve generalizability and allow robust analysis. Expected Outcome:Faster extubation in the RS group could justify the higher drug cost by saving OR time, improving efficiency, reducing staff stress, and optimizing resource use — especially relevant for developing healthcare systems.