Sugammadex Versus Neostigmine: A Comparative Study of Efficacy and Safety in the Cath Lab

Background Effective and complete reversal of neuromuscular blockade is essential for safe recovery from general anesthesia. This becomes more significant in patients undergoing cardiac procedures as they have limited cardiopulmonary reserve and reduced tolerance for physiological instability. Neostigmine is the conventional agent of choice for the reversal of non-depolarizing neuromuscular blockade. However, its use is associated with variable efficacy and unwanted side effects such as bradycardia and bronchoconstriction. Sugammadex, a novel relaxant binding agent, reverses neuromuscular blockade by encapsulating free rocuronium molecules, thereby rapidly diminishing their functional presence at the neuromuscular junction. Compared with neostigmine, sugammadex has demonstrated accelerated and more predictable reversal, including from a deeper level of blockade. Materials and methods The current study is a prospective, randomized, triple-blinded interventional study done for a period of one year in a tertiary care hospital in India. Fifty adult patients scheduled for an elective cardiac catheterization procedure under general anesthesia were randomized into two equal groups (n=25 each) to receive either sugammadex or neostigmine for the reversal of neuromuscular blockade. The primary aim was to compare the efficacy and safety of sugammadex and neostigmine in reversing moderate neuromuscular blockade, defined as the reappearance of the second twitch (T2) on train-of-four (TOF) monitoring until the attainment of a TOF ratio of ≥0.9, in adult patients undergoing cardiac catheterization procedures under general anesthesia. Secondary objectives included evaluating adverse event profiles and time to discharge readiness from the post-anesthesia care unit (PACU) using the modified Aldrete score. Results The mean time from the reappearance of the second twitch (T2) on TOF monitoring until the attainment of a TOF ratio of ≥0.9 was significantly shorter in the sugammadex group as compared to the neostigmine group (t=14.42; p<0.001). Time to PACU discharge readiness was also significantly reduced with sugammadex (50.24±17.89 minutes) compared with neostigmine (65±15.45 minutes; t=3.15; p=0.002). Adverse effects occurred less frequently in the sugammadex group. Conclusion Sugammadex provides a swifter, more predictable, and safer reversal of neuromuscular blockade compared with neostigmine in patients undergoing cardiac catheterization procedures. Sugammadex facilitates earlier recovery and improved postoperative outcomes in the cath lab setting.