Abstract

Background: Reversal of rocuronium-induced neuromuscular blockade is important for achieving adequate recovery before extubation. Sugammadex and neostigmine differ in their mechanisms of action and speed of reversal. Aim: To compare sugammadex and neostigmine for reversal of rocuronium-induced neuromuscular blockade under general anaesthesia. Methods: This randomised controlled study included 60 participants, with 30 assigned to receive sugammadex and 30 to receive neostigmine. The groups were compared for baseline characteristics, time to achieve a train-of-four (TOF) ratio of at least 0.9, extubation time, time to reach an Aldrete score of at least 9, haemodynamic measurements after reversal, and adverse effects. Results: Baseline characteristics were comparable between groups. Mean time to reach a TOF ratio of at least 0.9 was shorter with sugammadex than with neostigmine (2.9 ± 2.2 vs 9.1 ± 3.5 minutes; mean difference −6.20 minutes, 95% CI −7.72 to −4.68; p < 0.001). Recovery to TOF ≥0.9 within 3 minutes occurred in 70.0% and 6.7% of participants, respectively (p < 0.001). Mean extubation time was 6.8 ± 1.6 minutes with sugammadex and 10.2 ± 2.1 minutes with neostigmine; mean time to Aldrete score ≥9 was 13.8 ± 2.9 and 18.9 ± 3.6 minutes, respectively (both p < 0.001). Haemodynamic differences were not consistent across measurement times. Bradycardia and postoperative nausea and vomiting were numerically less frequent with sugammadex, but neither individual comparison was statistically significant. The composite adverse-event rate was lower with sugammadex (13.3% vs 40.0%; p = 0.020). Conclusion: Sugammadex was associated with faster neuromuscular recovery, extubation, and early recovery than neostigmine in this study. The haemodynamic and adverse-event findings should be interpreted cautiously given the small sample and multiple unadjusted haemodynamic comparisons.

Keywords: Sugammadex, Neostigmine, Neuromuscular blockade