The comparision of sugammadex with desflurane and propofol anesthesia in the recovery of neuromuscular blockadedone by the infusion of rocuronium

Sugammadex is a drug that reverses the effect of neuromuscular blocking agents. In contrast to other traditional drugs (such as acetylcholinesterase inhibitors, neostigmine), it can rapidly reverse deep neuromuscular blockade without any partial reversal.Sugammadex effects by binding and encapsulating rocuronium molecules and reducing their concentrations in neuromuscular junctions. In our study, the effects of desflurane and propofol anesthesia on the action time of sugammadex were compared by using TOF and BIS monitoring in 64 cases from the ASA I-II risk group, between the ages of 18 and 65,and undergoing rhinoplasty in the Department of Plastic, Reconstructive and Esthetic Surgery. The patients had been informed in detail regarding the study and their written informed consents were obtained.The patients? medical history was recorded, their physical examination was performed and their ASA risk scores were determined.The cases were randomized into 2 groups, which were the Desflurane Group (Group D, n=32) and the Propofol Group (Group P, n=32).For ECG monitoring, the patients were followed by using the DII derivation.Non-invasive arterial blood pressure monitoring, peripheral pulse oximetry monitoring, end-tidal carbon dioxide monitoring, neuromuscular monitoring (TOF Watch SX, Organon) and bispectral index monitoring (BIS XP Platform) were performed on the patients.At both grup (Grup P and Grup D) anesthesia was induced with ivpropofol and remifentanil.Afterremifentanil loading (1 µg kg-1 min-1), propofol was administered by titration with 10 mg doses following a loading dose of 2 mgkg-1. Titration was performed by maintaining BIS values below 60.Orotracheal intubation was performed after sufficient muscle relaxation (TOF = 0) was achieved with 0,6 mg kg-1rocuronium.Anesthesia maintenance was ensured in Group P with 5-12 mg kg-1 hour-1propofol(TIVA) and 0,2-0,5 µg kg-1 min-1remifentanil infusion, and in Group D with 1 MAC (6%) desflurane and 0,2-0,5 µg kg-1 min-1remifentanil infusion. Anesthesia maintenance was performed such that the BIS values were constantly kept between 40 and 60.All patients were started on 6 µgr kg-1 min-1rocuronium infusion.Patients were monitored such that their intraoperative TOF values and their PTC values would remain below 0 and 10, respectively.The intraoperative hemodynamic parameters, TOF and BIS values of the cases were recorded.In both groups, rocuronium infusion was interrupted 10 minutes before the end of the surgery.In Group D, desflurane concentration was decreased by 50% when the last surgical sutures were being performed.In Group P, propofol infusion was reduced to 4 µg kg-1 min-1.Remifentanil infusion was then interrupted in both groups.All study drugs were discontinued at the end of surgery.In both groups, 4 mgr kg-1sugammadex was administered when the TOF value was 1; the TOF values were then recorded once every 15 seconds.The patients were extubated when the TOF ratio reached 90%. Following this, the times that elapsed until a TOF ratio of 100% was achieved were recorded.Patients were kept under observation for 30 minutes at the postoperative care unit, and visited in their wards during the 3rd postoperative hour. The time that elapsed for a TOF ratio of 0.9 or above to be achieved was determined as 66,56±13,70seconds (1,1 min) for Group D, and 83,91±20,82 seconds (1,3 min) for Group P.Patients remained hemodynamically stable following the administration of sugammadex, with no side effects or post-residual curarization being observed. In patients with T1 responses observed during TOF monitoring following rocuronium infusion under desflurane or propofol anesthesia, it was determined that single-dose sugammadex was effective in reversing neuromuscular blockade without any residual or repeating blocks being observed, and that sugammadex ensured rapid and safe reversal with both anesthesia. In our study, we have determined that, in terms of extubation time and the time necessary for reaching 90 % TOF or above,sugammadex use is both effective and safe for reversing the effect of rocuronium used for muscle relaxation in adult patients undergoing rhinoplasty surgery. The efficacy and safety of sugammadex were independent of the method of anesthesia.Following rocuronium infusion, sugammadex ensures rapid, full and safe restoration of neuromuscular function. Key Words: Desflurane, propofol, sugammadex