Introduction: Use of neuromuscular blocking agents in general anaesthesia has been linked to postoperative residual curarization (PORC) which is associated with various postoperative pulmonary complications.Ultrasonography can be used as an alternative to acceleromyography for the assessment of PORC. Sugammadex is reported to provide more complete and faster reversal of rocuronium based neuromuscular blockade in comparison to neostigmine. 

Aim of Study: To compare the recovery of respiratory muscle strength using ultrasonography after reversal of rocuronium-induced neuromuscular blockade with sugammadex versus neostigmine in the post extubation period.

Materials & methods: A prospective randomized double blinded study will be conducted on 50 adult patients posted for microlaryngeal surgery under general anaesthesia after obtaining a written informed consent. Enrolled patients will be randomly divided into two equal groups to receive either sugammadex 2mg/kg or neostigmine 0.05mg/kg with glycopyrolate 0.01 mg/kg as reversal agent at end of surgery. Ultrasonography will be performed to measure diaphragm excursion (DIA) and thickening fraction of internal oblique muscle (TFIO) before induction of anaesthesia (baseline level), postextubation at train of four ratio (TOFR) ≥ 0.9 in the OR, and at 30 minutes in the PACU. Outcomes of the study are change in DIA and change in TFIO from baseline to postextubation (at TOFR ≥ 0.9) and from baseline to 30 minutes in the PACUin both the groups. The data thus collected will be statistically analysed.

Clinical Significance: Residual neuromuscular blockade is prevalent but often underdiagnosed, therefore adequate prevention is necessary for better outcomes and lesser complications. Adequate reversal of the effect of muscle relaxants and assessment of muscle strength recovery in the postanaesthesia period is essential to avoid residual neuromuscular blockade.