الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Morbidly obese patients present many challenges for anaesthesia including an increased incidence of immediate post-operative respiratory complications following reversal of neuromuscular blocking agents. Sugammadex may be superior to neostigmine to attain rapid respiratory recovery for such patients.
Forty morbidly obese adult patients (18-60 yrs., ASA I /II status) were studied to compare between sugammadex and neostigmine regarding respiratory recovery following reversal of anaesthesia-associated neuromuscular blockade in elective laparoscopic cholecystectomy or bariatric surgery.
Patients in this study were randomly categorized into two groups (20 patients for each): group I patients received neostigmine 50 µg/kg corrected body weight (CBW) and atropine 0.03 mg/kg CBW and group II patients received sugammadex 2.0 mg/kg CBW.
All patients were assessed by detailed routine examinations, investigations and vital signs, in addition to using El-Ganzouri index to predict risk of difficult tracheal intubation.
Prior to induction, Peak expiratory flow rate was measured and the results were recorded on a peak flow chart. For all patients an IV access was established and induction of anaesthesia was done by propofol 2 mg/kg CBW, fentanyl 1μg /kg CBW and rocuronium 0.6 mg/kg CBW prior to intubation.
A NMB reversal agent was administered at the end of the procedure when two responses on the TOF stimulation were achieved; either, sugammadex 2.0 mg/kg CBW or neostigmine 50 μg/kg CBW and atropine 0.03 mg/kg CBW. After reversal, neuromuscular function measurements were repeated every 15 seconds until a TOF ratio of 0.9 was reached.
Patients were extubated after full recovery and return of protective reflexes.5, 10 and 20 minutes after reversal, PEFR, VAS score and PONV were measured again and recorded.
Mean PEFR in group I was 333.5 (± 49.77) and in group II was 360.0(±86.69) Lt/sec (p= 0.243) preoperatively and showed a statistically significant difference postoperatively at 5 min postoperatively. In group I it was 148.0 (±48.95) and in group II it was 235.7 (±63.32) Lt/sec (p <0.001). Mean PEFR 10 min postoperatively in group I was 173.0 (±51.62) and in group II was 265.5 (±68.40) Lt/sec (p <0.001) and mean PEFR 20 min postoperative in group I was 211.5 (±59.23) and in group II was 316.5 (±77.95) Lt/sec (p <0.001).
Post-operative nausea and vomiting (PONV) showed statistically significant difference between two groups. Patients who had the need for anti-emetic therapy were 50% in group I and were 15% in group II (p= 0.018).
Visual Analogue Scale (VAS) score showed statistically significant difference between two groups as mean VAS score in group I was 4.73 (±1.48) and in group II was 2.38 (± 0.86) (p <0.001).
It was concluded that, Compared to neostigmine, sugammadex leads to better recovery of respiratory function as measured by Peak Expiratory Flow Rate (PEFR) following reversal of NMB of general anaesthesia in morbidly obese patients