A comparative study on the efficacy of sugammadex (2 mg/kg) in reversing rocuronium- and vecuronium-induced neuromuscular blockade in elective neurosurgery patients

A comparative study on the efficacy of sugammadex (2 mg/kg) in reversing rocuronium- and vecuronium-induced neuromuscular blockade in elective neurosurgery patients - Background: Neurosurgery demands precise anaesthetic management to ensure immobility, smooth extubation, and rapid recovery. Sugammadex, a novel neuromuscular reversal agent, provides rapid and effective recovery from neuromuscular blockade. Aims and Objectives: This study aimed to compare the efficacy of 2 mg/kg Sugammadex in reversing neuromuscular blockade maintained with Rocuronium or Vecuronium infusion in patients undergoing elective neurosurgery. The primary objective was to compare the mean recovery time from the initiation of Sugammadex administration at the reappearance of TOF count 1 to achieving a train-of-four (TOF) ratio of 0.9. Secondary objectives included assessing side effects, hemodynamic changes, and signs of postoperative residual curarization (PORC). Materials and Methods: In this prospective, randomized, double-blinded study, 60 patients scheduled for elective neurosurgery were divided into two groups: Group RS (Rocuronium infusion, n = 30) and Group VS (Vecuronium infusion, n = 30). At the end of surgery, all patients received Sugammadex 2 mg/kg for neuromuscular blockade reversal. The mean recovery time, incidence of PORC, postoperative respiratory complications, side effects, and hemodynamic changes following Sugammadex administration were compared between the groups. Results: The mean recovery time to achieve a TOF ratio of 0.9 after Sugammadex administration was 130.16 ± 26.07 seconds in Group RS and 139.33 ± 33.13 seconds in Group VS. The difference was statistically insignificant (p = 0.238). There were no incidences of PORC or postoperative respiratory complications in either group. Side effects and hemodynamic parameters were comparable and statistically insignificant between the groups. Conclusion: A dose of 2 mg/kg Sugammadex is equally effective for reversing Rocuronium- and Vecuronium-induced neuromuscular blockade in elective neurosurgery. It demonstrates a favourable safety profile with no significant side effects in either group. Keywords: Sugammadex, Vecuronium, Rocuronium, Neuromuscular Blockade, TOF Monitoring.