Comparison of Sugammadex and Neostigmine in Terms of Awakening, Pain, Agitation, Nausea and Vomiting in Pediatric Patients''

Lower abdominal surgery and urogenital surgery are frequently performed surgeries in the pediatric patient population aged 5-12 years. Therefore, pain, agitation, nausea and vomiting occurring in the early postoperative period and afterwards are important problems for pediatric patients. The incidence of agitation, which is a postoperative behavioral disorder due to the use of sevoflurane and desflurane, varies between 2 and 80%, depending on the scoring system and anesthesia technique. It is more common in preschool children (3-5 years). Agitation despite spontaneous resolution; It is still considered a potentially serious complication due to the risks of self-harm and the stress it causes in the family. It can also cause pain and bleeding, prolonging the recovery period (1). Therefore, it is a problem that should be avoided.

Neostigmine is the most commonly used agent for reversing neuromuscular blockade (NMB) (2). Cholinesterase inhibitor agents used in decurarization have serious side effects, especially because they stimulate the muscarinic system as well as nicotinic receptors (3). These are hypersalivation, bradycardia, bronchoconstriction, nausea and vomiting, and abdominal cramps (4).

Sugammadex is a cyclodextrin group drug, which is an aminosteroid neuromuscular blocking agent, has a selective effect on rocuronium and vecuronium and mechanically binds these molecules, providing rapid excretion and decurarization. Recurarization and muscarinic side effects are not expected in this type of decurarization(5). When acetylcholine esterase inhibitors are used to reverse neuromuscular block, they can cause postoperative residual curarization (PORC)(6).

Postoperative nausea and vomiting (PONV) is a common complication in the pediatric population. The incidence in children varies between 33.2% and 82% depending on the risk factors of the patient. This rate is twice that of adults. PONV typically describes nausea, vomiting, or retching. It may start in the recovery unit and continue for 24 hours. PONV causes dehydration, electrolyte disturbances, longer stay in the recovery unit, A< it causes delays and ultimately a significant financial burden(7). Therefore, it is a complication that should be avoided as much as possible.

Pain is the most important risk factor in the development of agitation. In order to reduce all these complications, we hypothesized that sugammadex was superior to neostigmine + atropine in reducing side effects compared to decurarization.In this study, it was aimed to compare the use of sugammadex instead of neostigmine + atropine in the reversal of NMB in children undergoing lower abdominal surgery or urogenital surgery, and to compare the rates of postoperative agitation, nausea and vomiting using the FLACC scale, PAED scale and ICC parameters.After the approval of the local ethics committee and written consent from the family, patients who underwent ASA 1, 5-12 years old lower abdomen surgery or urogenital surgery in Pendik Training and Research Hospital will be included in the study.