Comparing sugammadex and neostigmine reversal of neuromuscular blockade in laparoscopic surgery


We read the article by Geldner et al. [1] with great interest and congratulate the authors for demonstrating that sugammadex is a potential agent for achieving reliable, complete and rapid reversal at varying depths of neuromuscular blockade. Although the article is of great clinical relevance, we feel that there are certain methodological issues that require clarification. Firstly, could the authors kindly describe how they ensured a post-tetanic count of 1-2 (deep blockade) at the end of surgery? Secondly, the authors have not specified whether, if the patient did not have a post-tetanic count of 1–2 at the end of surgery in the sugammadex group, an additional dose of the neuromuscular blocking agent was given or whether the patient was excluded from the study. We suggest that an improved methodology would have been to randomise the patients at the end of the surgery, just before administration of the study drugs, and that patients who did not meet the required neuromuscular block for administration of the drug could be excluded from the study.