Evaluation of sugammadex for vecuronium-induced neuromuscular blockade: A comparison with neostigmine

Background: Sugammadex is a selective relaxant binding agent that quickly reverses neuromuscular blockade (NMB) induced by rocuronium and, to a lesser extent, by vecuronium. Aims and Objectives: This study aimed to compare the effectiveness of sugammadex with that of neostigmine in reversing vecuronium-induced NMB in patients undergoing elective surgery. Materials and Methods: A total of 100 patients who were 18 years or older, classified as American Society of Anesthesiologists Class I-III, and scheduled for a surgical procedure involving sevoflurane and opioid anesthesia received an initial intubating dose of vecuronium (0.1 mg/kg), along with maintenance doses of 0.02–0.03 mg/kg upon reappearance of the second twitch (T2) of train-of-four (TOF) if needed. NMB was monitored using acceleromyography (TOF-Watch). At the end of the surgery, following the reappearance of T2 after the last vecuronium dose, participants were randomly assigned to receive either sugammadex (2 mg/kg) or neostigmine (50 μg/kg) combined with glycopyrrolate (10 μg/kg) intravenously. The main efficacy endpoint assessed was the duration from the onset of administration of sugammadex or neostigmine to the recovery of the TOF ratio to 0.9. Results: The geometric mean duration to achieve a TOF ratio of 0.9 was significantly shorter with sugammadex compared to neostigmine (2.6 min, 16.1 min, respectively; P≤0.0001). The average recovery times to a TOF ratio of 0.8 and 0.7 were also significantly quicker with sugammadex. No major adverse events or unexpected side effects occurred with either medication. Conclusion: Sugammadex resulted in a significantly faster reversal of vecuronium-induced NMB compared to neostigmine.