Modern anaesthesia includes analgesia, amnesia and muscle relaxation caused by neuromuscular blockers. Muscle relaxation makes endotracheal intubation easier and facilitates operations in large body cavities like the abdomen and thorax without the need for very deep anaesthesia. Drugs designed to relax muscles do so by stopping acetylcholine from binding to its receptor. It is necessary to use some kind of artificial respiration when the diaphragm and intercostal muscles in the chest are paralysed. When the laryngeal muscles are also paralysed, an endotracheal tube is typically required to protect the airway.

The effects of muscle relaxants are commonly reversed at the end of surgery by anticholinesterase drugs, which are administered in combination with muscarinic anticholinergic drugs to minimize side effects. Pancuronium, rocuronium, vecuronium, cisatracurium, atracurium and mivacurium are some examples of skeletal muscle relaxants in use now a days.

Rocuronium is a monoquaternary steroid analogue of vecuronium, designed to provide a rapid onset of action. It undergoes no metabolism and is mostly removed by the liver and a small amount by the kidneys. Its duration of action is not significantly affected by renal disease, but it is modestly prolonged by severe liver failure and pregnancy.

Acetylcholine binding to nicotinic cholinergic receptors on the motor end-plate is necessary for normal neuromuscular transmission. The nondepolarizing relaxant’s redistribution, diffusion, excretion and metabolism from the body are all necessary for blockade reversal (spontaneous reversal), which is frequently aided by certain reversal drugs (pharmacological reversal). In order to restore normal neuromuscular transmission, cholinesterase inhibitors indirectly increase the quantity of acetylcholine to compete with the nondepolarizing agent.

Neostigmine is made up of a quaternary compound and carbamate moiety. Neostigmine’s (0.05 mg/kg) effects often start to show after five minutes, peak after ten, and last for more than an hour. The action time of this drug is prolonged in elderly patients. When an anticholinergic drug is administered beforehand or concurrently, muscarinic adverse effects are reduced. The conditions urinary bladder atony, paralytic ileus and myasthenia gravis are also managed with neostigmine.

Sugammadex, a type of modified gamma -cyclodextrin, is a special substance that selectively binds relaxants. Due to its three-dimensional structure, a 1:1 water-soluble guest-host complex is tightly formed. This prevents the medication from interacting with nicotinic acetylcholine receptors and causing a neuromuscular block in extracellular fluid. Sugammadex does not need to be administered with an antimuscarinic medication because it is generally excreted intact through the kidneys. Both superficial and deep rocuronium-induced neuromuscular blockade are consistently reversed quickly and effectively by it. Sugammadex is not advised for people with severe kidney disease (creatine clearance 30 mL/min) due to its renal excretion.

This study is being done as sugammadex is a newer drug and there are fewer studies done in comparison with neostigmine. Therefore, the present study is designed as a randomised controlled trial to evaluate and compare the sugammadex and neostigmine related side effects on both the groups after reversal.