Effect of sugammadex versus neostigmine/glycopyrrolate combination on peak expiratory flow rates in adult patients undergoing laparoscopic surgery

ABSTRACT Background and Aims: Residual neuromuscular blockade impacts peak expiratory flow rate (PEFR). The primary aim of this study was to compare post-extubation PEFR in adults undergoing laparoscopic cholecystectomy when neuromuscular blockade was reversed by either neostigmine or sugammadex. Methods: Patients aged 18–60 years were randomised into two equal groups of 43 each based on the reversal agent used – sugammadex versus neostigmine. Pre- and post-operative PEFRs were recorded using a handheld flow-type spirometer. Percentage reduction in forced expiratory volume in first second (FEV1), forced vital capacity (FVC), and FEV1/FVC were calculated. Adverse events and recovery scores were compared between the two groups. Results: The post-operative PEFR with sugammadex was 336.88 ± 65.94 L/min, compared to 293.93 ± 43.76 L/min with neostigmine. The mean difference was statistically significant {42.95 L/min [95% confidence interval (CI): 18.95–66.95 L/min], P = 0.001}. The mean percentage reduction in PEFR from baseline was significantly lower with sugammadex (9.66 ± 6.11%) compared to neostigmine (16.33 ± 10.9%). The median time to extubation with sugammadex was 3 min [interquartile range (IQR): 3–4)], and 7 min (IQR: 6–8) with neostigmine ( P = 0.001). The time to achieve modified Aldrete score >8 with sugammadex was shorter by an absolute difference of 8.814 (CI = 10.28–7.35) min. No incidence of post-operative pulmonary complication (PPC) was reported in either group. Conclusion: Reversal of neuromuscular blockade with sugammadex is associated with higher post-operative values of PEFR when compared with neostigmine. Higher values of PEFR and FEV1, FVC, and FEV 1 /FVC ratio after surgery shorten the time to extubation, minimise PPC, and facilitate early post-operative recovery.