Sugammadex bests Neostigmine in faster recovery of rocuronium induced neuromuscular block

Recent research found that Sugammadex has accelerated the recovery of the rocuronium-induced neuromuscular block when compared with Neostigmine. The study was published in the Journal of Cardiothoracic and Vascular Anesthesia. It had the added advantage of reduced incidence of postoperative pulmonary complications and duration of postoperative hospital stay. 

Lung cancer has the highest mortality and morbidity globally. Surgery is the main mode of management and muscle relaxants are used to induce muscle paralysis. Sugammadex is a gamma-cyclodextrin drug that inactivates nondepolarizing NMB agents in the vascular system. Researchers conducted a study to compare the effect of sugammadex and neostigmine on neuromuscular block reversal and the incidence of postoperative pulmonary complications in patients undergoing lung cancer resection. 

A double-blind, randomized, prospective study in a single major urban teaching and university hospital on one hundred adult patients who underwent elective radical resection of lung cancer under general anesthesia. Patients were randomized into neostigmine (0.05 mg/kg) + atropine 0.02 mg/kg group and sugammadex (2 mg/kg) group. The primary outcomes were the incidence of any postoperative pulmonary complications and the time to achieve 90% of train-of-four (TOF) after the administration of sugammadex or neostigmine. The secondary endpoints were the number of patients with a TOF ratio (TOFr) <0.9 at the time of tracheal extubation, the incidence of readmission 30 days after discharge, and specific postoperative pulmonary complications.

Results:

• The average time of recovery to TOFr ≥0.9 with sugammadex was 164.5 ± 27.7 seconds versus 562.9 ± 59.7 seconds with neostigmine + atropine treatment.
• Fewer sugammadex-treated patients did not achieve a TOFr of 0.9 at the tracheal extubation than neostigmine-treated participants.
  
• Patients in the sugammadex group had a lower incidence of postoperative lung complications, and shorter durations of post-anesthesia care unit stay and postoperative hospital stay than those in the neostigmine group.

No significant difference was observed in the incidence of readmission between the 2 groups. 

Thus, administration of sugammadex provided faster recovery of the rocuronium-induced neuromuscular block when compared with neostigmine. 

Further reading: https://doi.org/10.1053/j.jvca.2022.03.033

Yu Y, Wang H, Bao Q, Zhang T, Chen B, Ding J. Sugammadex Versus Neostigmine for Neuromuscular Block Reversal and Postoperative Pulmonary Complications in Patients Undergoing Resection of Lung Cancer. J Cardiothorac Vasc Anesth. 2022;36(9):3626-3633.