الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Neuromuscular blocking agents are frequently used
during anesthesia to facilitate tracheal intubation, artificial
ventilation, and surgical procedures. However, late recovery,
increased costs and adverse effects, due to these NMBs are still
subjects of concerns [216].
Postoperative residual curarization (PORC) is one of the feared
complications after anesthesia. With advances in monitoring and
continued studies, a TOF <0.9 is now considered as residual
neuromuscular blockade. This more stringent ratio was arrived after
several studies demonstrated an increased risk of aspiration and
pharyngeal dysfunction at TOF <0.9, and impaired inspiratory flow
and partial airway obstruction at TOF <0.8. Therefore, TOF
monitoring was important in this study to provide an objective
assessment and therefore accepted cut-off value was TOF ratio >0.9
[108].
Cholinesterase inhibitors are traditionally used for reversal of
neuromuscular blockade. Among these agents neostigmine is the most
potent and selective one. It should be kept in mind that cholinesterase
inhibitor agents have multi-systemic side effects. Because these agents
are not selective to nicotinic receptors and also stimulate the muscarinic
system, there can be quite a few serious adverse effects as follows:
Bradycardia, QT lengthening, bronchoconstriction, hypersalivation and
increased motility [5].
With the invention of sugammadex, a completely new
possibility of neuromuscular block reversal was introduced to
anesthesia practice. The modified γ-cyclodextrin sugammadex is the
Summary
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first in a new class of selective relaxant binding agents [134].
Sugammadex has been shown to provide predictable, complete and
rapid reversal of both moderate and deep rocuronium- and
vecuronium-induced NMB [135].
The aim of this study was to compare between the Sugammadex
and Neostigmine as regard to efficacy, safety and side effects in
pediatric patients undergoing adenotonsillectomy procedures
Fourty pediatric patients undergoing elective
adenotonsillictomy operation with standrized propofol-fentanylrocuronium-
isoflurane anesthetic technique were devided randomly
into two equal groups (n=20) either receive sugammadex 2mg/kg or
neostigmine 0.03mg/kg + atropine 0.01mg/kg. At the end of the
operation when T2 appeared by train of four (TOF) watch ”SX model
acceleromyograph” monitoring, when TOF ratio > 90% was reached,
patients were extubated. Time to reach TOFR > 90% after reverse,
hemodynamic alteration and side effects were recorded and compared.
In this work, patients in sugammadex group attained a TOF
ratio 90% was statistically shorter time (88 ± 45.4 seconds) than those
in neostigmine group (415.8 ± 227.5 seconds), heart rate was
significantly higher at 2,5 and 10 minute in neostigmine group.
Comparison of adverse effects yielded no difference ”Vomiting in three
cases with sugammadex and four cases with neostigmine, and one case
developed desaturation in the two groups”.
In conclusion, sugammadex, a selective relaxant binding
agent, rapidly and effectively reverses rocuronium-induced NMB in
pediatric patients undergoing adenotonsillectomy when administered at
reappearance of T2 of TOF at dose 2 mg/kg, and was well tolerated
overall in the children with no statistically difference in side effects.