Anesth Pain Med.  2019 Jul;14(3):288-293. 10.17085/apm.2019.14.3.288.

Comparison of sugammadex and pyridostigmine bromide for reversal of rocuronium-induced neuromuscular blockade in short-term pediatric surgery: a prospective randomized study

• An J
• Kim E
• Lee J
• Kim H
• Son J
• Huh J
• Woo K

• KMID: 2454813
• DOI: http://doi.org/10.17085/apm.2019.14.3.288

Abstract

BACKGROUND
Sugammadex reverses rocuronium-induced neuromuscular blockade quickly and effectively. Herein, we compared the efficacy of sugammadex and pyridostigmine in the reversal of rocuronium-induced light block or minimal block in pediatric patients scheduled for elective entropion surgery.
METHODS
A prospective randomized study was conducted in 60 pediatric patients aged 2-11 years who were scheduled for entropion surgery under sevoflurane anesthesia. Neuromuscular blockade was achieved by administration of 0.6 mg/kg rocuronium and assessed using the train-of-four (TOF) technique. Patients were randomly assigned to 2 groups receiving either sugammadex 2 mg/kg or pyridostigmine 0.2 mg/kg and glycopyrrolate 0.01 mg/kg at the end of surgery. Primary outcomes were time from administration of reversal agents to TOF ratio 0.9 and TOF ratio 1.0. Time from the administration of reversal agents to extubation and postoperative adverse events were also recorded.
RESULTS
There were no significant differences in the demographic variables. Time from the administration of reversal agents to TOF ratio 0.9 and TOF ratio 1.0 were significantly shorter in the sugammadex group than in the pyridostigmine plus glycopyrrolate group: 1.30 ± 0.84 vs. 3.53 ± 2.73 min (P < 0.001) and 2.75 ± 1.00 vs. 5.73 ± 2.83 min (P < 0.001), respectively. Extubation time was shorter in the sugammadex group. Adverse events, such as skin rash, nausea, vomiting, and postoperative residual neuromuscular blockade (airway obstruction), were not statistically different between the two groups.
CONCLUSIONS
Sugammadex provided more rapid reversal of rocuronium-induced neuromuscular blockade in pediatric patients undergoing surgery than did pyridostigmine plus glycopyrrolate.

Keyword

Delayed emergence from anesthesia; Neuromuscular monitoring; Pediatrics; Pyridostigmine bromide; Rocuronium; Sugammadex

MeSH Terms

Anesthesia
Delayed Emergence from Anesthesia
Entropion
Exanthema
Glycopyrrolate
Humans
Nausea
Neuromuscular Blockade*
Neuromuscular Monitoring
Pediatrics
Prospective Studies*
Pyridostigmine Bromide*
Vomiting
Glycopyrrolate
Pyridostigmine Bromide

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