الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Fast-track cardiac anaesthesia, which offers extubation within six hours postoperatively, allows early mobilization and hospital discharge in an effort to reduce costs and perioperative morbidity. It demands the use of short acting NMBs, combining the ability to provide sufficient neuromuscular blocking and immediate recovery at the end of surgery. NMBAs are used for induction of anesthesia and maintenance of anaesthesia during surgery. Postoperative residual paralysis is a significant problem in cardiac surgery which is associated with hypoventilation, airway obstruction and hypoxia. Neuromuscular blockade titrated using neuromuscular monitoring can help to maintain good or excellent operative conditions. Sugammadex is a modified g-cyclodextrin which acts by rapidly encapsulating steroidal NMBs such as rocuronium. Sugammadex in a dose of at least 2 mg/kg is not associated with cardiovascular side effects and it does not need administration of anticholinergic drugs unlike cholinesterase inhibitors. As the depth of anesthesia cannot be reliably judged by the cardiovascular measurements alone, a reliable method is needed to measure the hypnotic component of sedation and anesthesia. The entropy monitor (state entropy and response entropy) measures the degree of disorder in the EEG. The aim of this study was to test the hypothesis that use of sugammadex to reverse the effect of rocuronium might be associated with more haemodynamic stability and better recovery criteria than neostigmine in combination with atropine. Forty patients aged from one to five years old who were undergoing closed cardiac surgery were randomly allocated to receive sugammadex 2mg/kg in S group(n.=20) or a combination of neostigmine 40µg/kg and atropine 15µg/kg in N group (n.=20) at the end of surgery as a reversal to rocuronium. Data regarding the hemodynamics including mean blood pressure and heart rate were recorded before and after reversal injection and for two hours postoperative. Entropy values, TOF ratio, time to reach TOF≤ 0.9 (extubation time) and recovery profile assessed by modified Aldrete score were assessed. There was a significant increase in the mean values of mean arterial blood pressure and heart rate in N group for 1o minutes after reversal injection in comparison to S group. The extubation time was significantly shorter in (S) group than (N) group. There was increase in response entropy values 30 seconds after injection of sugammadex and immediately after extubation. No adverse events were detected in both groups. Conclusion: The present study demonstrates that sugammadex provided safe and effective reversal for pediatric cardiac surgery with shorter extubation time, more hemodynamic stability than neostigmine-atropine which is the basic goal after cardiac surgery.