Elective abdominal surgeries are planned procedures, and can include procedures like appendectomy, cholecystectomy, hernia repair, and colorectal surgery, often performed laparoscopically for better recovery.

Laparoscopic surgery is now widely established. Benefits include reduced postoperative pain, improved cosmetic results and patient satisfaction, and reduced hospital stays. The range of surgical techniques is increasing in complexity and now includes cholecystectomy, adrenalectomy, nephrectomy, fundoplication, hernia repair, bowel resection and gynaeco logical procedures,where  general anaesthesia is preferred.

Sugammadex is a new reversal agent that works differently than cholinesterase inhibitor neostigmine .It  binds with high affinity to vecuronium and rocuronium in blood decreasing its plasma concentration and creating a gradient between the plasma and the neuromuscular junction, This process results in removing the non depolarizing agent from there  receptors as it follows the concentration gradient towards the blood.

 A dose of 4mg/kg and 2 mg/kg has been established for reversal of deep and shallow neuromuscular block induced by rocuronium and vecuronium.[4]However   the high cost of this drug is prohibitive and is a significant limitation for its routine use in many institutions, especially when higher doses are required.Few studies have suggested that  a  dose of 0.22 mcg/kg Sugammadex and 34mcg/kg neostigmine accelerates recovery from TOF ratio of 0.5 to a ratio of at least 0.9 in an average of 2 min .

We hypothesize that the combination of neostigmine with half dose sugammadex (1mg/kg) would be non inferior to 2mg/kg recommended dose in reversing vecuronium induced shallow NMB.Given the high cost of Sugammadex this multimodal approach would be an effective cost reducing method ,while preserving the advantage of this novel agent .