A Retrospective Study of Comparison Between Neostigmine Versus Sugammadex as Reversal Agent in Patients Posted for Interventional Pulmonolgy Procedures
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Background and aims
Patients for interventional pulmonary procedures (IPP) are inherently high risk due to various comorbidities as well as the procedure being variable in duration and adverse events. Incomplete muscle reversal can delay rapid recovery and lead to adverse events in the postoperative period. Sugammadex as a reversal agent, may offer distinct advantages when residual neuromuscular blockade is poorly tolerated. Limited data is available on use of suggamadex in high risk IPP regaurding extubation times and adverse events. Studies on pulmonary complications and anaphylaxis in this subset of pulmonary patients is controvertial. Moreover in the Indian setup optimizing the turnaround time to justify the cost of suggamadex for IPP is yet to be determined. In this retrospective study we will compare the advantages of using Sugammadex over the conventional reversal agent Neostigmine for time to extubation and time to shifting the patient to PACU in patients undergoing IPP. The hemodynamic parameters and adverse events will also be noted.
Materials and methods
After ethics approval from institute (EC/OA-48/2025) we conducted a retrospective cohort study of 70 adults (18-60yrs) for a duration of 6 months in our institute who underwent IPP under general anaesthesia (tracheal dilation, tracheal biopsy, EBUS TBNA,BAL etc). They were categorized into two groups: Group A-suggamadex vs. Group B-neostigmine. TOF monitoring was recorded and time to extubation and shift to PACU was noted along with hemodynamics and adverse effects. The statistical software SPSS version 16 was used for the analysis.
Results
A total of 70 patients were included. Patients in Group sugammadex showed less time to extubate (5.80±0.96 vs 13.26±1.88, P value 0.0001) and discharge from PACU (10.49±1.44 vs 28.57±3.34 min, P = 0.000003) than in Group neostigmine. The difference between heart rate, blood pressure and respiratory rate and adverse events were not statistically significant.
Conclusion
Sugammadex shortens the time to extubate and discharge from PACU in patients undergoing IPP, accelerating recovery and turnaround time. No additional adverse events or hemodynamic instability were noted with suggamadex in this subset of patients. No coughing irritable airway.
