Sugammadex versus neostigmine for reversal of rocuronium-induced neuromuscular blockade in infants: A prospective randomized pilot study

Background: This study aimed to compare sugammadex and neostigmine for the antagonism of rocuroniuminduced neuromuscular block in pediatric patients with biliary atresia and impaired liver function undergoing Kasai operation. Methods: Forty pediatric patients below three months of age underwent the Kasai operation. When the surgery ended and the second response (T2) to train-of-four (TOF) stimulation was detected, patients were randomly assigned to receive either 50 mu g/kg neostigmine combined with 20 mu g/kg atropine, or 2 mg/kg sugammadex. We recorded the time between receiving the neostigmine or sugammadex and reaching corrected TOF ratios of 0.9 and 1.0. We also noted their length of stay in the post-anesthesia care unit (PACU) and any incidents of postoperative recurrence of neuromuscular blockade or other adverse events during recovery. Results: The times taken to reach TOF ratios of 0.9 and 1.0 after sugammadex were shorter than after neostigmine (p<0.001). The mean duration of PACU stay was also shorter with the use of sugammadex compared to neostigmine (22.55 +/- 5.76 min vs. 40.50 +/- 7.93 min; p<0.001). We did not record any incidents of postoperative recurrence of neuromuscular blockade after administration of either treatment .The total number of patients who suffered from post-operative vomiting were statistically lower in the sugammadex group than in the neostigmine group (2 vs. 9; p = 0.03). One patient (5%) in the sugammadex group versus 13 patients (65%) in the neostigmine group developed tachycardia (p<0.001). Conclusions: Sugammadex at a dose of 2.0 mg/kg is a safe, quick, and efficacious reversal agent to rocuroniuminduced neuromuscular blockade (NMB) in pediatric patients below three months of age undergoing the Kasai operation, with a lower incidence of post-operative tachycardia, vomiting, and shivering than neostigmine.