Abstract PR443

Background & Objectives: Sugammadex can reverse deep neuromuscular blockade monitored as posttetanic count (PTC) 1-2. To recognize precisely whether the level of neuromuscular blockade is deep or not, it is crucial to use neuromuscular function monitoring devices. On the other hand, neostigmine has no indication to reverse deep neuromuscular blockade, and it was reported that the incidence of incomplete recovery (Train of four (TOF) ratio < 0.9) was higher compared with sugammadex. These facts may affect the motivation of anesthesiologists for the use of neuromuscular function monitoring devices. Therefore, we studied whether the difference in reversal agents has an effect on the manner of neuromuscular monitoring. Materials & Methods: Under the approval by our institutional committee, we reviewed the records of all patients to whom sugammadex (between April 1st and 30th in 2012) or neostigmine with atropine (between January 1st and 31st in 2013) was administered before extubation to reverse neuromuscular blockade. Among these patients we extracted the patients monitored by neuromuscular function monitoring devices, who were allocated to one of two groups (Sugammadex group and Neostigmine group) depending on the reversal agents. Thereafter, we investigated TOF count, and ratio or PTC just before the administration of reversal agents. Finally, we counted the patients who reached TOF ratio 0.9 and examined the last value of TOF ratio after extubation. Results: The numbers of patients reversed by the drugs and monitored by devices are summarized in Table 1. The number of Neostigmine group was smaller than that of Sugammadex group, because the superiority of sugammadex became gradually recognized during the study period. The percentages of patients monitored by devices were not significantly different. In Sugammadex and Neostigmine groups, 19 (79%) and 4 (67%) of patients insignificantly reached TOF count 4 (TOF ratios were 37 ± 39% and 21 ± 27%) just before the administration of reversal agents, respectively. There were no patients who recovered from PTC 1-2. In Sugammadex group all the patient reached TOF 0.9, while only 1 (20%) patient reached TOF 0.9 in Neostigmine group (P < 0.01). The last value of TOF ratio after extubation was significantly higher in Sugammadex group (97 ± 4 %) than in Neostigmine group (78 ± 8%).Conclusion: There was no significant difference in the percentage of patients monitored by neuromuscular function monitoring devices, and under the devices, patients were reversed at almost the similar level (not deep) of neuromuscular blockade regardless of reversal agents although the results should be cautiously interpreted because of the small number of Neostigmine group. As mentioned in the previous report, most of the patients reversed by neostigmine could not reach TOF ratio 0.9, thus the reversal by the drug should be accomplished with vigilance. Disclosure of Interest: J. Kuribayashi Conflict with: speaker’s fee, K. Seo Conflict with: speaker’s fee