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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 91 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. |