Evaluating clinical features of reversed non depolarizing block by using train- of -four (TOF) responses recorded by acceleromyography device in pediatric patients

Sixty children age between 2-12 in ASA I-II scheduled for elective surgery in supine position were enrolled to this randomized, prospective, double-blinded study after the permission of local ethics committee and parents written informed consent. Patients were randomized to two groups as Group I (sugammadex) and Group II (neostigmine). Propofol (2mg/kg) and fentanyl (1?g/kg) were administered for induction and sevoflurane for maintenance of anaesthesia. Neuromuscular function was monitored by acceleromyography (TOF Watch SX) and train-of-four (TOF) mode of stimulation. Rocuronium (0.6mg/kg) was used for NMB and 0.1-0.2 mg/kg additional doses were given if necessary. At reappearance of T2, sugammadex 2mg/kg in group I and neostigmine 0.06mg/kg+atropine 0.02 mg/kg in group II were administered. Patients were extubated after TOF 0.9 was achieved. No statistically significant difference was observed between the groups according to age, gender, weight, duration of operation, mean arterial pressure, SpO2, fentanyl and rocuronium usages (p>0.05).Heart rate decreased significantly after reversal agent in group I at 15th,30th and 60th seconds of evaluation whereas it increased significantly in group II (p<0.0004).Time from administration of reversal agent to TOF 0.9 was faster with sugammadex (68 second) than with neostigmine (392 second) (p<0.001). Muscle strength was significantly higher in group I than in group II. The result of this study shows sugammadex is a safe and effective agent for reversing rokuronium–induced NMB in paediatric patients with a faster recovery of neuromuscular function than neostigmine.