Sugammadex Preserves Lung Function Better Than Neostigmine After Laparoscopic Cholecystectomy, RCT Finds
A recent randomized controlled trial published in the Indian Journal of Anaesthesia in May 2026 shows that sugammadex preserves post-extubation lung function significantly better than neostigmine following laparoscopic cholecystectomy, yielding a higher peak expiratory flow rate (336.88 vs. 293.93 L/min). This superior respiratory protection dramatically shortens extubation times and speeds up patient recovery.
Although residual neuromuscular blockade (RNMB) increases perioperative risks and previous meta-analyses revealed that sugammadex reduced postoperative pulmonary complications (PPCs) by 38% compared to acetylcholinesterase inhibitors, direct comparative evaluation of post-extubation PEFR remained unstudied. To resolve this clinical gap, Dr. Penna Srihitha and colleagues from the Department of Anaesthesia and Intensive Care at Postgraduate Institute of Medical Education and Research, Chandigarh, India, aimed to compare 30-minute post-extubation PEFR following sugammadex versus neostigmine/glycopyrrolate reversal in adults undergoing laparoscopic cholecystectomy.
Therefore, the single-center, prospective, double-blind randomized trial evaluated 86 adult laparoscopic surgery patients assigned to receive either sugammadex (2 mg/kg) or neostigmine (50 µg/kg) with glycopyrrolate for neuromuscular reversal at train-of-four count 4. Excluding individuals with respiratory disease, obesity, or emergency status, the study compared post-extubation peak expiratory flow rate alongside secondary spirometric and recovery parameters.
Key Clinical Findings of the Trial Includes:
- Superior Peak Expiratory Flow: The trial demonstrated a significantly higher post-operative PEFR with sugammadex compared to neostigmine (336.88 ± 65.94 L/min vs. 293.93 ± 43.76 L/min; mean difference 42.95 L/min; P = 0.001), showing a smaller baseline reduction (9.66% vs. 16.33%).
- Attenuated Volume Reduction: Investigators recorded lower post-operative percentage drops in FEV1 (17.08% vs. 37.04%), FVC (12.06% vs. 28.69%), and FEV1/FVC ratio (4.55% vs. 10.64%) in the sugammadex cohort (all P = 0.001).
- Faster Tracheal Extubation: The trial documented a significantly shorter median extubation time of 3 minutes (interquartile range [IQR]: 3–4) for sugammadex versus 7 minutes (IQR: 6–8) for neostigmine (P = 0.001).
- Rapid Recovery Readiness: Researchers noted faster achievement of a modified Aldrete score >8 with sugammadex (median 12 vs. 21 minutes; absolute difference −8.81 minutes; P = 0.001) alongside lower post-operative pain scores (1 vs. 2; P = 0.001).
- Hemodynamic and Oxygenation Stability: The trial showed higher post-operative peripheral oxygen saturation (median 100% vs. 99%; P = 0.005) and lower heart rates with sugammadex, without any pulmonary complications or drug toxicity.
The results suggest that sugammadex reversal effectively preserves post-operative lung function by producing a 42.95 L/min mean increase in PEFR over neostigmine, thereby lessening spirometric decline while accelerating extubation by a median difference of 3.74 minutes. Additionally, this approach shortens post-anesthesia recovery time by nearly 9 minutes, fostering operational surgical efficiency.
Thus, the study concludes clinicians may consider using sugammadex over traditional neostigmine combinations for neuromuscular blockade reversal following laparoscopic surgery to optimize post-operative pulmonary mechanics and patient recovery.
Although single-center design, modest sample size, and absence of diaphragmatic ultrasonography represent minor study limitations, future multi-center investigations incorporating diaphragm imaging could further clarify these respiratory advantages across diverse populations.
Reference
Srihitha P, Saini V, Samra T, Ganesh V, Mahajan V, Naik BN. Effect of sugammadex versus neostigmine/ glycopyrrolate combination on peak expiratory flow rates in adult patients undergoing laparoscopic surgery. Indian J Anaesth 2026;70:653‑61.
