COMPARISON OF LOW DOSE SUGAMMADEX WITH NEOSTIGMINE PLUS GLYCOPYRROLATE VERSUS NEOSTIGMINE PLUS GLYCOPYRROLATE FOR EXTUBATION

Abstract

Background: Residual neuromuscular blockade remains a significant cause of delayed recovery and postoperative respiratory complications following general anaesthesia. Neostigmine with glycopyrrolate is the conventional reversal regimen but may be associated with incomplete recovery. Sugammadex provides rapid and predictable reversal of aminosteroidal neuromuscular blocking agents. The use of low-dose sugammadex in combination with conventional reversal may improve recovery while minimizing cost. Objectives: To compare recovery characteristics following conventional reversal with neostigmine and glycopyrrolate versus neostigmine and glycopyrrolate followed by sugammadex 0.5 mg/kg. Methods: This prospective comparative study included 60 adult patients (ASA I–II) undergoing surgery under general anaesthesia with vecuronium-induced neuromuscular blockade. Patients were randomized into two groups of 30 each. Group N received neostigmine 0.05 mg/kg and glycopyrrolate 0.01 mg/kg. Group S received neostigmine 0.05 mg/kg, glycopyrrolate 0.01 mg/kg, and sugammadex 0.5 mg/kg. The primary outcome was extubation time. Secondary outcomes included time of eye opening, response to verbal commands, residual neuromuscular blockade, postoperative complications. Results: Baseline demographic and surgical characteristics were comparable between groups. Group S demonstrated significantly faster recovery than Group N. Extubation time was significantly reduced in Group S (8.20 ± 1.70 min) versus Group N (14.10 ± 2.90 min) (p<0.001). Eye opening, spontaneous respiration, and response to verbal commands occurred significantly earlier in Group S (p<0.001 for all comparisons). PACU stay was significantly shorter in Group S (55.20 ± 10.80 min) compared with Group N (74.50 ± 13.40 min) (p<0.001). Residual neuromuscular blockade occurred in 16.7% of patients in Group N and none in Group S (p=0.020). Conclusion: The addition of low-dose sugammadex (0.5 mg/kg) to conventional neostigmine-glycopyrrolate reversal significantly improved neuromuscular recovery, reduced extubation time, shortened PACU stay, and decreased residual neuromuscular blockade. This combination may represent a safe and effective strategy for improving postoperative recovery following general anaesthesia.