Electromyographic activity of the diaphragm during neostigmine or sugammadex-enhanced recovery after neuromuscular blockade with rocuronium: A randomised controlled study in healthy volunteers

BACKGROUNDThe use of neuromuscular blocking agents has been associated with severe postoperative respiratory morbidity. Complications can be attributed to inadequate reversal, and reversal agents may themselves have adverse effects. OBJECTIVETo compare the electromyographic activity of the diaphragm (EMGdi) during recovery from neuromuscular blockade using neostigmine and sugammadex. The hypothesis was that there would be better neuromuscular coupling of the diaphragm when sugammadex was used. DESIGNA randomised, controlled, parallel-group, single-centre, double-blinded study. SETTINGDistrict general hospital in Belgium. PARTICIPANTSTwelve healthy male volunteers. INTERVENTIONSIndividuals were anaesthetised with propofol and remifentanil. After rocuronium 0.6 mg kg−1, a transoesophageal electromyography (EMG) recorder was inserted. For reversal of neuromuscular blockade, volunteers received sugammadex 2 mg kg−1 (n = 6) or neostigmine 70 μg kg−1 (n = 6). MAIN OUTCOME MEASURESEMGdi, airway pressure and flow were continuously measured during weaning from the ventilator until tracheal extubation. Arterial blood gas samples were obtained for PaO2 and PaCO2 analysis at the first spontaneous breathing attempt and after tracheal extubation. RESULTSDuring weaning, 560 breaths were retained for analysis. The median (95% CI) peak EMGdi was 1.1 (0.9 to 1.5) μV in the neostigmine group and 1.6 (1.3 to 1.9) μV in the sugammadex group (P 
Source: European Journal of Anaesthesiology - Category: Anesthesiology Tags: Monitoring Source Type: research