• Yea-Ji Lee, Ah-Young Oh, Bon-Woo Koo, Ji-Won Han, Jae-Hee Park, Jung-Pyo Hong, and Kwang-Suk Seo.
• From the Department of Anaesthesiology and Pain Medicine, Konkuk University Medical Centre, Seoul (Y-JL), Department of Anaesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam-si (A-YO, J-WH, J-HP, J-PH), Department of Anaesthesiology and Pain Medicine, Seoul National University College of Medicine (B-WK) and Department of Dental Anaesthesiology, Seoul National University Dental Hospital, Seoul, South Korea (K-SS).
• Eur J Anaesthesiol. 2020 Mar 1; 37 (3): 196-202.

BackgroundIncomplete recovery of neuromuscular blockade is a common postoperative adverse event in the postanaesthesia care unit.ObjectiveWe examined and compared the incidence of residual neuromuscular blockade when the recommended dose of neostigmine or sugammadex was administered according to a qualitative nerve stimulator response.DesignA randomised controlled trial.SettingA tertiary care hospital in South Korea from September 2017 to November 2017.PatientsEighty patients aged between 18 and 69 years were included in this study. All were patients scheduled to undergo elective laparoscopic cholecystectomy and who had an American Society of Anaesthesiologists physical status of one or two were eligible.InterventionsPatients were allocated randomly to receive neostigmine or sugammadex at the end of surgery. The doses of the reversal agents were based on the response to peripheral nerve stimulation, which was discontinued after administration of the reversal agent.Main Outcome MeasuresThe primary outcome was the incidence of postoperative residual neuromuscular blockade. The secondary outcomes were the incidences of symptoms or signs of residual neuromuscular blockade such as hypoxaemia, inability to maintain head-lift for 5 s and diplopia.ResultsThe incidence of residual neuromuscular blockade on arrival in the recovery room was 44.4% in the neostigmine group and 0% in the sugammadex group (P < 0.0001, relative risk = 1.80, 95% confidence interval 1.36 to 2.41). The incidences of adverse events in the recovery room were low and comparable between the groups.ConclusionThe incidence of residual neuromuscular blockade on arrival in the recovery room was significantly higher in the neostigmine group than that in the sugammadex group. However, the incidence of adverse events was similar in the neostigmine and sugammadex groups.Trial RegistrationClinicalTrials.gov identifier: NCT03292965.

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