Comparing the effects of sugammadex and neostigmine on neuromuscular block and bispectral index in recovery from intracranial mass resection operations

INTRODUCTION: Neuromuscular recovery (NMR) is a critical part of recovery from general anesthesia. Neostigmine is a choline esterase inhibitor and one of the leading agents which are used for NMR from non-depolarizing neuromuscular block. Its effect depends on competitive antagonism of the neuromuscular blocking agent (NMBA) in the neuromuscular junction (NMJ). Sugammadex is a new agent which has attracted attention with dramatically rapid NMR from non-depolarizing neuromuscular blocking agents (NDNMBAs). It effects via chemically antagonizing NMBAs.
METHODS: Effects of neostigmine and sugammadex concerning recovery from general anesthesia for intracranial mass excision operations were compared. Totally 60 patients were included in the study. Neostigmine was used for 30 patients, and sugammadex was used for 30 patients. Evaluation criteria were the train of four (TOF), bispectral index (BIS), Glasgow Coma Scale (GCS), Modified Aldrete Score (MAS), Ramsey Sedation Score (RSS), vital signs and existed complications.
RESULTS: It is observed that NMR and recovery from anesthesia were significantly shorter in the sugammadex group (p<0,05). It is also seen that the duration of attaining BIS level to 80 was significantly shorter in the sugammadex group but this result is attributed to the artifact of the rapidly increasing neuromuscular activity in the sugammadex group.
DISCUSSION AND CONCLUSION: We suggest that both neostigmine and sugammadex are useful agents for NMR. Sugammadex has more advantages than neostigmine because of rapid onset of action without increased complications but much more studies are needed about sugammadex to take the place of neostigmine.