Bradycardia in Ophthalmic Surgery: A Care-Bundle, Not Drug-to-Drug, Comparison [Response to Letter]

Intraoperative NMBA Effects, Not Reversal RegimensLin et al raised a valid point regarding the timing of reversal agents.We agree that reversal agents are administered at the end of anesthesia; however, our study was designed to investigate intraoperative bradycardia.As defined in our Methods section (Objectives and Outcomes), the primary outcome was "bradycardia during surgical manipulation" an event occurring while rocuronium or cisatracurium was actively providing neuromuscular blockade, and significantly before the administration of corresponding reversal agents.Therefore, the observed difference in bradycardia rates reflects the pharmacological properties of the NMBAs (vagolytic effect of rocuronium) rather than the reversal agents.Our title-"Comparison of Rocuronium and Cisatracurium"-further emphasizes that our research question focused on intraoperative NMBA effects, not reversal regimens. 2