Half-dose sugammadex with neostigmine versus full-dose sugammadex for reversal of rocuronium in laparoscopic bariatric surgery
Ghanem, M., Nasr, M., el Aziz Motawee, A., El-kenany, S. (2020). Half-dose sugammadex with neostigmine versus full-dose sugammadex for reversal of rocuronium in laparoscopic bariatric surgery. EKB Journal Management System, 12(1), -. doi: 10.1186/s42077-020-00067-w
Mohamed A. Ghanem; Mohamed Nasr; Abd el Aziz Motawee; Samah El-kenany. "Half-dose sugammadex with neostigmine versus full-dose sugammadex for reversal of rocuronium in laparoscopic bariatric surgery". EKB Journal Management System, 12, 1, 2020, -. doi: 10.1186/s42077-020-00067-w
Ghanem, M., Nasr, M., el Aziz Motawee, A., El-kenany, S. (2020). 'Half-dose sugammadex with neostigmine versus full-dose sugammadex for reversal of rocuronium in laparoscopic bariatric surgery', EKB Journal Management System, 12(1), pp. -. doi: 10.1186/s42077-020-00067-w
Ghanem, M., Nasr, M., el Aziz Motawee, A., El-kenany, S. Half-dose sugammadex with neostigmine versus full-dose sugammadex for reversal of rocuronium in laparoscopic bariatric surgery. EKB Journal Management System, 2020; 12(1): -. doi: 10.1186/s42077-020-00067-w

Half-dose sugammadex with neostigmine versus full-dose sugammadex for reversal of rocuronium in laparoscopic bariatric surgery

Ain-Shams Journal of Anesthesiology
Volume 12, Issue 1, January 2020  XML PDF (675.48 K)
DOI: 10.1186/s42077-020-00067-w
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Authors
Mohamed A. Ghanem email orcid ; Mohamed Nasr; Abd el Aziz Motawee; Samah El-kenany
Abstract
Background
Sugammadex reverses rocuronium more effective than neostigmine during deeper neuromuscular blockade levels. Relying upon the high cost of sugammadex we hypothesized that combined neostigmine with half-dose sugammadex (1.2 mg/kg) would be as effective as the full dose (2.4 mg/kg IBW) in reversing rocuronium-induced deep neuromuscular block in obese patients. A multimodal approach would be an effective cost saving strategy, while preserving the advantages of this novel agent.
Patient and methods
A prospective randomized study done on 50 morbid obese patients undergoing elective laparoscopic sleeve gastrectomy operation. Patients were allocated into two groups each of 25. Group NS received sugammadex 1.2 mg/kg and neostigmine 50 μg/kg with atropine 20 μg/kg. Group S received sugammadex 2.4 mg/kg and 10 mL of normal saline.
Primary outcome
Interval between administration of reversal and reaching TOF of 90%.
Secondary outcomes
Total dose of rocuronium (mg), duration between last dose rocuronium and reverse, number of patients reached TOF of 90% within 5 min, duration between IV reversal and extubation, and the number of patients with residual neuromuscular blockade.
Results
Number of patients who reached TOF 90% within 5 min, the interval between reversal and 90% TOF, the interval between reversal and extubation were comparable between the study groups.
Conclusion
As regards neuromuscular blocker reversal in obese patients, the neostigmine 50 μg/kg plus sugammadex half dose (1.2 mg/kg) is as effective as full-dose sugammadex (2.4 mg/kg) alone.
Trial registration
Institutional Research Board: (IRB code number): on 16 January 2018.
Keywords
Sugammadex; Neostigmine; Morbid Obese; Laparoscopic sleeve gastrectomy; Rocuronium
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