ABSTRACT Background and Aims: Residual neuromuscular blockade impacts peak expiratory flow rate (PEFR). The primary aim of this study was to compare post-extubation PEFR in adults undergoing laparoscopic cholecystectomy when neuromuscular blockade was reversed by either neostigmine or sugammadex. Methods: Patients aged 18–60 years were randomised into two equal groups of 43 each based on the reversal agent used – sugammadex versus neostigmine. Pre- and post-operative PEFRs were recorded using a handheld flow-type spirometer. Percentage reduction in forced expiratory volume in first second (FEV1), forced vital capacity (FVC), and FEV1/FVC were calculated. Adverse events and recovery scores were compared between the two groups. Results: The post-operative PEFR with sugammadex was 336. 88 ± 65. 94 L/min, compared to 293. 93 ± 43. 76 L/min with neostigmine. The mean difference was statistically significant 42. 95 L/min 95% confidence interval (CI): 18. 95–66. 95 L/min, P = 0. 001. The mean percentage reduction in PEFR from baseline was significantly lower with sugammadex (9. 66 ± 6. 11%) compared to neostigmine (16. 33 ± 10. 9%). The median time to extubation with sugammadex was 3 min interquartile range (IQR): 3–4), and 7 min (IQR: 6–8) with neostigmine (P = 0. 001). The time to achieve modified Aldrete score >8 with sugammadex was shorter by an absolute difference of 8. 814 (CI = 10. 28–7. 35) min. No incidence of post-operative pulmonary complication (PPC) was reported in either group. Conclusion: Reversal of neuromuscular blockade with sugammadex is associated with higher post-operative values of PEFR when compared with neostigmine. Higher values of PEFR and FEV1, FVC, and FEV 1 /FVC ratio after surgery shorten the time to extubation, minimise PPC, and facilitate early post-operative recovery.
Srihitha et al. (Fri,) studied this question.