A comparison of intravenous sugammadex and neostigmine plus atropine reversal on time to consciousness during wake-up tests in spinal surgery


BİRİCİK E. , Alic V., KARACAER F. , Celiktas M., ÜNLÜGENÇ H.

NIGERIAN JOURNAL OF CLINICAL PRACTICE, cilt.22, ss.609-615, 2019 (SCI İndekslerine Giren Dergi) identifier identifier identifier

  • Cilt numarası: 22 Konu: 5
  • Basım Tarihi: 2019
  • Doi Numarası: 10.4103/njcp.njcp_633_18
  • Dergi Adı: NIGERIAN JOURNAL OF CLINICAL PRACTICE
  • Sayfa Sayısı: ss.609-615

Özet

Objective: The effect of sugammadex on consciousness is not yet fully understood. This prospective, randomized, double-blind, multicenter study was performed to compare the effects of intravenous (IV) sugammadex and neostigmine + atropine reversals on time-to-consciousness during intraoperative wake-up tests in patients undergoing spinal surgery. Subjects and Methods: A total of 66 American Society of Anesthesiologists IuII patients aged 10u25 years undergoing spinal surgery were recruited. In all patients, bispectral index (BIS), motor-evoked potential (MEP), somatosensory-evoked potentials (SSEP), and train-of-four (TOF) scores were monitored. Patients received the same total IV anesthesia protocol with a propofoluremifentanil mixture. Patients were randomly allocated into two groups. During wake-up test, when the TOF count reached 2 (T2), either sugammadex 2 mg.kg(1) in group S or neostigmine 0.04 mg.kg(1) + atropine 0.01 mg.kg(1) in group N were administered. BIS90, SSEP90, MEP90 was recorded when TOF ratio reached 90, whereas time-to-consciousness (Timecons) was recorded when the patient responded to verbal commands. Results: BIS90 (77.4 4.7, 74.8 3.7), SSEP90(36 9.9, 29.7 8.5), and MEP90 (465.3 34.8, 431.3 28.2) values were significantly greater in group S than in group N (P < 0.05 for each variables). Timecons was significantly shorter with sugammadex than with the neostigmine + atropine combination (P < 0.05). Conclusion: Using IV sugammadex 2 mg.kg(1) reversal provides faster responses to verbal commands than neostigmineuatropine combination during the intraoperative wake-up test in patients undergoing spinal surgery because the time to consciousness was significantly shorter. This difference was thought to be related with faster return of neuromuscular transmission because the TOF ratio was 0.9 well before return of consciousness in both groups.