European Journal of Cardiovascular Medicine

Background: Postoperative nausea and vomiting (PONV) significantly affect patient recovery following general anesthesia, particularly in breast surgery patients. Objective: To compare the effects of sugammadex versus neostigmine–glycopyrrolate on PONV incidence and severity in patients undergoing breast surgery under general anesthesia. Method: In this double-blind randomized controlled trial at Indira Gandhi Institute of Medical Sciences, 84 eligible breast surgery patients were randomly assigned to two groups receiving either sugammadex (2 mg/kg) or neostigmine (0.05 mg/kg) with glycopyrrolate (0.01 mg/kg) for neuromuscular blockade reversal. PONV was assessed at defined intervals post-extubation using a 4-point scale over 12 hours. Data on PONV episodes, need for rescue antiemetics, and adverse events were collected and statistically analyzed using mean ± standard deviation (SD), percentages, and p-values. Result: The sugammadex group demonstrated a significantly lower PONV incidence of 15% ± 4.2 compared to 35% ± 5.1 in the neostigmine group. The mean PONV scores were 0.8 ± 0.4 for sugammadex versus 1.5 ± 0.6 for neostigmine. The requirement for rescue antiemetics was 10% in the sugammadex group versus 28% in the neostigmine group. Statistical analysis revealed this reduction was significant (p=0.03). Calculations showed a relative risk reduction of 57% with sugammadex, supported by a 95% confidence interval. The standard deviation values indicate consistent performance within each group, reinforcing the robustness of the findings. Conclusion: Sugammadex substantially reduces the incidence and severity of PONV compared to neostigmine–glycopyrrolate, suggesting its preferable use in breast surgery patients.

Background: Postoperative respiratory complications (PRCs) remain a significant source of morbidity and extended hospitalization following general anesthesia. Identification of preoperative and intraoperative risk factors is essential to implement preventative strategies. Objective: To identify and evaluate independent risk factors contributing to PRCs in adult patients undergoing elective surgeries under general anesthesia. Methods: In this prospective observational study, 300 adult patients undergoing elective surgery under general anesthesia were enrolled over 12 months. Data on demographic, clinical, anesthetic, and surgical variables were collected. Postoperative respiratory complications (e.g., hypoxia, pneumonia, bronchospasm, and re-intubation) were recorded during the first 72 hours post-surgery. Multivariate logistic regression was used to determine independent predictors. Results: PRCs occurred in 48 (16%) patients. Independent risk factors included age ≥ 65 years (OR 2.4, 95% CI 1.3–4.2), ASA class III/IV (OR 3.1, CI 1.7–5.7), preexisting pulmonary disease (OR 4.2, CI 2.1–8.6), smoking history (OR 2.3, CI 1.2–4.6), surgery duration >3 hours (OR 2.1, CI 1.1–4.0), and inadequate reversal of neuromuscular blockade (OR 3.9, CI 1.9–7.8). Conclusion: PRCs are multifactorial and more common in elderly patients, those with pulmonary disease, and prolonged surgeries. Optimizing respiratory function preoperatively and ensuring adequate neuromuscular reversal may reduce incidence.

Introduction: Residual neuromuscular blockade following rocuronium administration can cause serious postoperative complications. Neostigmine has been the traditional reversal agent but is limited by slower onset and adverse muscarinic effects. Sugammadex, a novel selective relaxant binding agent, offers rapid and complete reversal. This study compared the recovery profile and adverse events between sugammadex and neostigmine. Aim: To compare sugammadex and neostigmine for reversal of rocuronium block with respect to recovery profile and adverse events. Methods: A prospective, randomized comparative study was conducted on 100 ASA I-II patients undergoing elective surgeries under general anesthesia. Patients were allocated into two groups (n=50 each): Group S received sugammadex 2 mg/kg, while Group N received neostigmine 0.05 mg/kg with glycopyrrolate 0.01 mg/kg at reappearance of the second TOF count. Primary outcome was time to TOF ratio ≥0.9. Secondary outcomes included extubation time, PACU stay, Aldrete recovery score, and adverse events. Data were analyzed using t-test, Chi-square/Fisher’s exact test, and results expressed with 95% confidence intervals. Results: Mean time to TOF ≥0.9 was significantly shorter in Group S (2.6 ± 0.8 min) compared to Group N (12.4 ± 3.1 min, p<0.0001). Extubation time and PACU stay were also reduced in Group S (6.9 ± 1.7 min vs 13.8 ± 3.4 min; 38.0 ± 9.0 min vs 52.0 ± 12.0 min; both p<0.0001). Adverse events occurred in 12% of Group S and 34% of Group N (p=0.0156). Residual paralysis and desaturation were observed only in the neostigmine group. Conclusion: Sugammadex provided rapid, reliable, and safer reversal of rocuronium block compared with neostigmine, with fewer adverse events and faster recovery. It may be particularly beneficial in high-risk patients where complete and prompt recovery is essential.

Background: Residual neuromuscular blockade can delay the recovery in paediatric patients and lead to postoperative complications. Both neostigmine & sugammadex are commonly used for reversing the neuromuscular blockade; however, onset, mechanism of action and recovery profile is significantly different. It is important to compare their efficacy in paediatric tonsillectomy to facilitate faster and safer recovery with minimal postoperative complications. Aims And Objective:  To evaluate the effectiveness of sugammadex versus neostigmine in paediatric adenotonsillectomy by comparing extubation time and postoperative complications such as hypotension, hypertension, bradycardia, anaphylactic reaction, vomiting & nausea in order to evaluate overall recovery and haemodynamic stability between the two groups. Methods:  This prospective, randomized study enrolled 128 paediatric patients (ASA grade I–II, aged 3–17 years) scheduled for adenotonsillectomy. Participants were randomly allotted into two different groups: Group S received sugammadex 2 mg/kg, while Group N received neostigmine 0.05–0.09 mg/kg combined with glycopyrrolate 0.008–0.15 mg/kg. General anaesthesia was standardized using propofol, fentanyl, and vecuronium. Recovery indices, extubation time, and postoperative clinical parameters were carefully recorded and compared.  Results:  A total of 128 paediatric patients were included in the study, with no significant differences in demographic characteristics between the two groups (p > 0.05). The mean extubation time was significantly shorter in the sugammadex group (2.6 ± 0.7 min) compared to the neostigmine group (7.0 ± 1.8 min; p < 0.001) Hemodynamic parameters remained stable in both groups; however, postoperative stability was better in the sugammadex group (p < 0.05).  Postoperative nausea and vomiting were reported only in the neostigmine group (40.6% and 12.5%; p < 0.001, p = 0.003). Overall, sugammadex achieved faster recovery and a lower incidence of adverse effects than neostigmine. Conclusion:  Compared to neostigmine, sugammadex is more effective in reversing vecuronium induced neuro muscular blockade. Sugammadex provides shorter extubation time with higher safety profile and less post operative complications. The incidence of PONV is very less with sugammadex as compared to neostigmine.

Background:  Acute respiratory distress syndrome (ARDS) carries high morbidity and mortality despite advances in critical care. Early application of evidence-based bundles (lung-protective ventilation, conservative fluids, early neuromuscular blockade when indicated) and prone ventilation for moderate–severe ARDS are guideline-supported strategies to improve outcomes.   Material and Methods:  This is a Prospective, single-centre, open-label, randomized controlled study conducted in a Department of Critical Care Medicine,  NRI Medical college and Hospital,  Guntur from August 2024 to July 2025. Comparing an Early Intervention + Early Prone Ventilation (EIPV) protocol (bundle initiation and first prone session within 24 h of ARDS diagnosis; prone ≥16 h/day) versus Usual Care (UC) (bundle per attending discretion; prone as rescue). Adults with Berlin-defined moderate–severe ARDS were included; major exclusions were refractory shock, unstable spinal injury, raised intracranial pressure, and do-not-intubate status. Primary outcome: 28-day all-cause mortality. Secondary outcomes: ventilator-free days (VFDs) to day-28, ICU/hospital length of stay (LOS), PaO₂/FiO₂ (PF) response after first and third prone sessions, need for rescue ECMO, and adverse events. Results: Groups remained well-balanced at baseline even with the smaller sample (30 vs 30), supporting internal validity. Even with 30 patients per arm, an early, protocolized prone strategy (EIPV) is associated with lower 28-day mortality and more efficient resource use (more ventilator-free days and shorter ICU/hospital stay). Earlier, prolonged proning in the EIPV arm still produces larger and more sustained improvements in oxygenation, consistent with guideline expectations, even in a 30 vs 30 cohort. Adverse events remain infrequent and acceptable. ECMO use trends lower in the EIPV arm, mirroring the pattern in the larger sample and aligning with literature suggesting better outcomes when prone is systematically applied (including in conjunction with ECMO). The greatest relative benefit of EIPV is seen in the most hypoxaemic subgroup (PF ≤100 mmHg) and in pneumonia-predominant ARDS, which is consistent with current guideline targeting of early prone ventilation in severe ARDS. After adjustment for age, baseline SOFA, and baseline PF ratio, EIPV remains independently associated with lower 28-day mortality. Increasing age and organ dysfunction are associated with higher mortality, whereas better baseline oxygenation (higher PF) is protective. Conclusion:  An early, protocolized bundle with early, prolonged prone ventilation was associated with lower 28-day mortality, more ventilator-free days, and improved oxygenation compared with usual care, with acceptable adverse-event rates. Findings align with contemporary guidelines recommending prone positioning ≥12–16 h/day in moderate–severe ARDS and support prioritizing timely implementation.1–4

Background: Succinylcholine  chloride  introduced in 1951 was a synthetic depolarising  muscle relaxant.  Succinylcholine with its adverse effects like hyperkalemia, raised intracranial, intraocular, intragastric pressures. Though  many NDMR drugs were introduced, Rocuronium bromide introduced in 1994 became first competitor for succinylcholine.  Rocuronium bromide when given in three times the ED95 doses is said to produce excellent to good  intubating  conditions in 60 seconds and devoid of adverse effects that are seen with succinylcholine.  Materials and Methods: This prospective, randomized study was conducted at the Department of Anaesthesia, Government Medical College and Hospital, Ongole after obtaining institutional ethical  committee approval. A total of 60 adult patients (aged 18–60 years) undergoing  elective surgeries under general anaesthesia were randomly assigned to either the Rocuronium bromide group (Group R, n = 30) or the Succinylcholine group (Group S, n = 30).The onset of neuromuscular blockade was assessed using a single twitch stimulation of 0.1Hz every 10sec after administration of either of the neuromuscular blocking agents.Jaw relaxation, vocal cord movement and Cormack Lehane grading were assessed at the time of intubation. Hemodynamic response to intubation was assessed by recording the preinduction,  and postintubation HR,SBP,DBP and MAP. Results: Incidence of Jaw relaxation was comparable between the two without statistical significance. Absence of vocal cord movements was comparable between the two groups without any statistical significance(Group R and Group S moving  P=0.21), (not moving Group R and Group S P=0.23). Cormack Lehane grading, no statistical significant difference between two groups. There is statistically significant difference in the onset of action of neuromuscular blockade between the two groups, with faster onset action in group S with P value 0.00001. Conclusion: Present study showed Succinylcholine showed an early onset muscle relaxation than Rocuronium. No difference in jaw relaxation and vocal cord movement at the intubation in two groups. There was no difference in hemodynamic response to intubation between the two drugs expect for more increase in pulse rate with rocuronium group.