Staggering Sugammadex for Reduction of Postoperative Complications: A Randomized Controlled Trial

Background: We investigated if staggering sugammadex would reduce postoperative  complications(with special regards to cough), compared to single dose of sugammadex or standard neostigmine in patients undergoing thyroidectomy surgery.

Methods: A 36 adult patients aged 21-60 years old, ASA I and II undergoing thyroidectomy surgery, were randomized into 3 groups; (S group) that received 2 mg/kg sugammadex as single bolus, (SS group) that received sugammadex 2 mg/kg in a staggered dose of 1 mg/kg prior to extubation and another 1 mg/kg immediately after extubation and (N group) that received 0.05 mg/kg neostigmine combined with 0.02 mg/kg atropine.

Results: Cough was absent in (SS) group. The percent of cough was 33% in S group and about 67 % in N group.Patients of (SS) and (S) groups had significant shorter recovery time and extubation time. Patients of (N) group showed significant increase in HR and SBP at 5 min after reversal compared to both (SS) and (S) groups, but no significant difference in DBP between all groups. There was no significant difference between all groups regarding postoperative complications other than cough.

Conclusion: Staggered sugammadex reduces significantly risks for cough on emergence when compared to 2mg single bolus sugammadex .In addition, staggered sugammadex-as well as bolus sugammadex-has better recovery and more stable hemodynamics when compared to neostigmine.