• Guy Cammu, Tom Schepens, Nikolaas De Neve, Davina Wildemeersch, Luc Foubert, and Philippe G Jorens.
• From the Department of Anaesthesiology and Critical Care Medicine, Onze-Lieve-Vrouw Ziekenhuis, Aalst (GC, NDN, LF); Department of Anaesthesiology, (TS, DW); Department of Critical Care Medicine, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium (PGJ).
• Eur J Anaesthesiol. 2017 Jan 1; 34 (1): 8-15.

BackgroundElectromyographic activity of the diaphragm (EMGdi) during weaning from mechanical ventilation is increased after sugammadex compared with neostigmine.ObjectiveTo determine the effect of neostigmine on EMGdi and surface EMG (sEMG) of the intercostal muscles during antagonism of rocuronium block with neostigmine, sugammadex and neostigmine followed by sugammadex.DesignRandomised, controlled, double-blind study.SettingIntensive care research unit.ParticipantsEighteen male volunteers.InterventionsA transoesophageal EMGdi recorder was inserted into three groups of six anaesthetised study participants, and sEMG was recorded on their intercostal muscles. To reverse rocuronium, volunteers received 50 μg kg neostigmine, 2 mg kg sugammadex or 50 μg kg neostigmine, followed 3 min later by 2 mg kg sugammadex.Main Outcome MeasuresWe examined the EMGdi and sEMG at the intercostal muscles during recovery enhanced by neostigmine or sugammadex or neostigmine-sugammadex as primary outcomes. Secondary objectives were the tidal volume, PaO2 recorded between the onset of spontaneous breathing and extubation of the trachea and SpO2 during and after anaesthesia.ResultsDuring weaning, median peak EMGdi was 0.76 (95% confidence interval: 1.20 to 1.80) μV in the neostigmine group, 1.00 (1.23 to 1.82) μV in the sugammadex group and 0.70 (0.91 to 1.21) μV in the neostigmine-sugammadex group (P < 0.0001 with EMGdi increased after sugammadex vs. neostigmine and neostigmine-sugammadex). The median peak intercostal sEMG for the neostigmine group was 0.39 (0.65 to 0.93) μV vs. 0.77 (1.15 to 1.51) μV in the sugammadex group and 0.82 (1.28 to 2.38) μV in the neostigmine-sugammadex group (P < 0.0001 with sEMG higher after sugammadex and after neostigmine-sugammadex vs. neostigmine).ConclusionEMGdi and sEMG on the intercostal muscles were increased after sugammadex alone compared with neostigmine. Adding sugammadex after neostigmine reduced the EMGdi compared with sugammadex alone. Unlike the diaphragm, intercostal EMG was preserved with neostigmine followed by sugammadex.Trial RegistrationEudraCT: 2015-001278-16; ClinicalTrials.gov: NCT02403063.

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