Sugammadex and neostigmine recovery indices in pediatric patients undergoing adenotonsillectomy-A prospective randomized study

This the comparative study between two drugs such as sugammadex and neostigmine which are used for reversal agent of choice during general anaesthesia. The primary objective of the study is to compare the post-operative parameters (bradycardia, hypotension, hypertension, fever, dry mouth, respiratory depression, anaphylactic reaction.etc.) after using sugammadex and neostigmine as a reversal agent of choice.

Secondary objective is to compare the time required for extubation after using sugammadex and neostigmine + glycopyrrolate.

Sugammadex is a cyclodextrin based medicine used during general anesthesia to reverse the neuromuscular blocking effect of vecuronium as well as rocuronium. Its molecular structure comprises a modified γ-cyclodextrin core featuring hydrophilic outer surfaces and a lipophilic central cavity. This distinctive arrangement allows sugammadex to create complexes with the steroidal components of specific neuromuscular blockers.by doing so sugammadex does not act on acetylcholine receptors present on the neuromuscular junction and quickly reverse the neuromuscular blockage.

Neostigmine is a widely recognized and frequently utilized reversal agent during general anesthesia. It operates as an acetylcholinesterase inhibitor, effectively acting on non-depolarizing neuromuscular blocking agents. This action allows neostigmine to counteract the effects of these agents by inhibiting the breakdown of acetylcholine, thereby promoting increased muscle contraction and reversing neuromuscular blockade.

In this study we are giving sugammadex for one group of patients undergoing adenotonsillectomy and neostigmine for one group undergoing adenotonsillectomy they are randomized in two different groups by computer generated chit methods.

Both drugs are given at the end of surgery once the procedure is over and different parameters are noted. Sugammadex is given as 2 mg/kg dose and neostigmine is given as 0.05 mg/kg. Muscle relaxant of choice in the study is vecuronium as sugammadex only acts on vecuronium and rocuronium.

Inclusion criteria for study are – 1] Pediatric patient undergoing adenotonsillectomy, 2] Age group – 3-17 years, 3] ASA grade I and II.

Exclusion criteria for study are – 1] Any cardiovascular hepatic impairment. 2] Creatinine clearance <30 mg/ml.