Effectiveness of partial and adjustment neostigmine dose as a neuromuscular reversal for single dose rocuronium

Background: Routine reversal (neostigmine) and the use of quantitative monitoring of neuromuscular blockade (Train of Four Ratio (TOFR)) are recommended to prevent the occurrence of residual paralysis. This study attempted to determine the effectiveness between neostigmine partial dose 0.02 mg/kgBW and adjusted dose based on TOFR value in recovering neuromuscular blockade of single dose rocuronium 0.6 mg/kg BW. Methods: This randomized clinical trial was performed in the operating room of Integrated Surgical Care Unit of Cipto Mangunkusumo General Hospital and Kirana Clinic. Sixty-one patients who underwent elective surgery with general anaesthesia were randomized into 2 groups: administration of neostigmine in partial dose 0.02 mg/kgBW (group A) and adjusted dose based on TOFR value (group B). Quantitative monitoring evaluation of neuromuscular blockade was performed four times: after adequate spontaneous breathing, 5, 10, and 15 minutes after reversal. Result: The mean of TOFR values in group A and group B respectively: after spontaneous breathing, 42% and 50% (p=0.436); 5 minutes after reversal, 80.2% and 89.2% (p=0.083); 10 minutes after reversal, 92.2% and 94% (p=0.399); 15 minutes after reversal, 94.3% and 94.9% (p=0.526). After the 5 minutes of reversal, group B (80.6%) reaches a TOFR value ≥ 90% which is more than group A (63.3%) (p=0.132). Conclusion: Neostigmine partial dose 0.02 mg/kgBW was as effective as administering neostigmine in adjustment dose based on TOFR values to achieve complete recovery from the neuromuscular block effect of single-dose rocuronium 0.6 mg/kg BW. This study also shows the complete recovery of the neuromuscular block when TOFR value ≥ 90%.